Provider Demographics
NPI:1558677112
Name:MILLER, DAN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:P
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19401 EAST VALLEY VIEW PARKWAY
Mailing Address - Street 2:EASTLAND CENTER
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055
Mailing Address - Country:US
Mailing Address - Phone:816-795-6325
Mailing Address - Fax:
Practice Address - Street 1:19401 EAST VALLEY VIEW PARKWAY
Practice Address - Street 2:EASTLAND CENTER
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055
Practice Address - Country:US
Practice Address - Phone:816-795-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010017941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist