Provider Demographics
NPI:1578567400
Name:MILLER, JACQUELINE MARIE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MARIE
Last Name:MILLER
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Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:1015 WASHINGTON SQUARE SHOPPING CTR
Mailing Address - Street 2:STE G
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-5307
Mailing Address - Country:US
Mailing Address - Phone:636-239-4004
Mailing Address - Fax:636-239-6576
Practice Address - Street 1:1015 WASHINGTON SQUARE SHOPPING CTR
Practice Address - Street 2:STE G
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-5307
Practice Address - Country:US
Practice Address - Phone:636-239-4004
Practice Address - Fax:636-239-6576
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO0153801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics