Provider Demographics
NPI:1568559870
Name:MILLER, PATRICIA ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELIZABETH
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 1:20 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-3305
Mailing Address - Country:US
Mailing Address - Phone:845-343-2500
Mailing Address - Fax:845-343-1077
Practice Address - Street 1:20 RIDGE ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3305
Practice Address - Country:US
Practice Address - Phone:845-343-2500
Practice Address - Fax:845-343-1077
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0385211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01093907Medicaid
NY01093907Medicaid