Provider Demographics
NPI:1689719759
Name:MILLER, JOHN D (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:D
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10393 S 1300 W
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8883
Mailing Address - Country:US
Mailing Address - Phone:801-254-1400
Mailing Address - Fax:801-254-7392
Practice Address - Street 1:10393 S 1300 W
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8883
Practice Address - Country:US
Practice Address - Phone:801-254-1400
Practice Address - Fax:801-254-7392
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT359803-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice