Provider Demographics
NPI:1669488847
Name:MILLER, STEVEN GREGORY (DMT)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GREGORY
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5409
Mailing Address - Country:US
Mailing Address - Phone:480-357-9334
Mailing Address - Fax:
Practice Address - Street 1:2424 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5409
Practice Address - Country:US
Practice Address - Phone:480-357-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00060P174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist