Provider Demographics
NPI:1568523090
Name:MILLER, MARLENE H (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:H
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5592 BROADVIEW RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1677
Mailing Address - Country:US
Mailing Address - Phone:216-351-9650
Mailing Address - Fax:216-351-9651
Practice Address - Street 1:5592 BROADVIEW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1677
Practice Address - Country:US
Practice Address - Phone:216-351-9650
Practice Address - Fax:216-351-9651
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30. 0152711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice