Provider Demographics
NPI:1598991770
Name:MILLER, JENNIFER DAWN
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DAWN
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8488
Mailing Address - Country:US
Mailing Address - Phone:770-614-8914
Mailing Address - Fax:770-614-8917
Practice Address - Street 1:1500 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8488
Practice Address - Country:US
Practice Address - Phone:770-614-8914
Practice Address - Fax:770-614-8917
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant