Provider Demographics
NPI:1659638583
Name:MILLER, CAITLIN MARY
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MARY
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 NEWCASTLE LN
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3120
Mailing Address - Country:US
Mailing Address - Phone:818-653-3196
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY S BLDG 1
Practice Address - Street 2:DENTAL CLINIC-NORTH BRONX HEALTHCARE NETWORK
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1119
Practice Address - Country:US
Practice Address - Phone:818-653-3196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program