Provider Demographics
NPI:1609843648
Name:MILLER, JOHN W (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
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 1:2323 N MAYFAIR RD
Mailing Address - Street 2:STE 102
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1506
Mailing Address - Country:US
Mailing Address - Phone:414-257-1161
Mailing Address - Fax:414-257-0194
Practice Address - Street 1:10521 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MEGUON
Practice Address - State:WI
Practice Address - Zip Code:53092
Practice Address - Country:US
Practice Address - Phone:262-241-0398
Practice Address - Fax:262-241-1368
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45120151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33735000Medicaid
U60874Medicare UPIN
WI775550003Medicare ID - Type Unspecified