Provider Demographics
NPI:1598713562
Name:MILLER, SUSAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
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 1:4905 HERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1714
Mailing Address - Country:US
Mailing Address - Phone:218-729-4970
Mailing Address - Fax:
Practice Address - Street 1:FOND DU LAC HUMAN SERVICES DIVISION
Practice Address - Street 2:927 TRETTEL LANE
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720
Practice Address - Country:US
Practice Address - Phone:218-879-1227
Practice Address - Fax:218-878-2188
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND9481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNAR2252093OtherDEA