Provider Demographics
NPI:1619005568
Name:MILLER, HARVEY EDWIN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:EDWIN
Last Name:MILLER
Suffix:JR
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 1:1046 MANGROVE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3548
Mailing Address - Country:US
Mailing Address - Phone:530-343-1402
Mailing Address - Fax:530-343-1403
Practice Address - Street 1:1046 MANGROVE AVE STE E
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3548
Practice Address - Country:US
Practice Address - Phone:530-343-1402
Practice Address - Fax:530-343-1403
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist