Provider Demographics
NPI:1619251014
Name:TOM J MILLER DDS PC
Entity Type:Organization
Organization Name:TOM J MILLER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-980-4988
Mailing Address - Street 1:150 S BLOOMINGDALE RD
Mailing Address - Street 2:#200
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1493
Mailing Address - Country:US
Mailing Address - Phone:630-980-4988
Mailing Address - Fax:630-980-1375
Practice Address - Street 1:231 S GARY AVE
Practice Address - Street 2:#107
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2234
Practice Address - Country:US
Practice Address - Phone:630-980-4988
Practice Address - Fax:630-980-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190191461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty