Provider Demographics
NPI:1598724189
Name:MILLER, SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 TOUHY AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3254
Mailing Address - Country:US
Mailing Address - Phone:847-933-1200
Mailing Address - Fax:847-933-1201
Practice Address - Street 1:5550 TOUHY AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3254
Practice Address - Country:US
Practice Address - Phone:847-933-1200
Practice Address - Fax:847-933-1201
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190180381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice