Provider Demographics
NPI:1639108061
Name:MILLER, MICHAEL FREDERICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FREDERICK
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2121
Mailing Address - Country:US
Mailing Address - Phone:315-446-8050
Mailing Address - Fax:
Practice Address - Street 1:4311 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:NY
Practice Address - Zip Code:13214-2121
Practice Address - Country:US
Practice Address - Phone:315-446-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0360151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice