Provider Demographics
NPI:1598935454
Name:MILLER, KEVIN THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THOMAS
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 1:121 S. PATTERSON AVE. #107
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111
Mailing Address - Country:US
Mailing Address - Phone:805-967-0272
Mailing Address - Fax:805-967-8997
Practice Address - Street 1:121 S. PATTERSON AVE. #107
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111
Practice Address - Country:US
Practice Address - Phone:805-967-0272
Practice Address - Fax:805-967-8997
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice