Provider Demographics
NPI:1558929679
Name:MILLER, LORI TUCKER (RDH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:TUCKER
Last Name:MILLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 SPRING ST PMB 266
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-8058
Mailing Address - Country:US
Mailing Address - Phone:360-317-7444
Mailing Address - Fax:
Practice Address - Street 1:238 SNOWBERRY LN
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-6148
Practice Address - Country:US
Practice Address - Phone:360-317-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00003038124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty