Provider Demographics
NPI:1619923448
Name:MILLER, PAUL E (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:4906 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-6013
Mailing Address - Country:US
Mailing Address - Phone:217-224-8002
Mailing Address - Fax:217-224-5703
Practice Address - Street 1:200 N 30TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3737
Practice Address - Country:US
Practice Address - Phone:217-224-8002
Practice Address - Fax:217-224-5703
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics