Provider Demographics
NPI:1659597342
Name:MILLER, LOREN MATTHEW (DDS)
Entity Type:Individual
Prefix:MR
First Name:LOREN
Middle Name:MATTHEW
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 1:5909 GLEN HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4561
Mailing Address - Country:US
Mailing Address - Phone:972-985-3300
Mailing Address - Fax:972-985-3949
Practice Address - Street 1:4975 PRESTON PARK BLVD
Practice Address - Street 2:190
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5164
Practice Address - Country:US
Practice Address - Phone:972-985-3300
Practice Address - Fax:972-985-3949
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist