Provider Demographics
NPI:1689747263
Name:MILLER, KERI L (DMD)
Entity Type:Individual
Prefix:DR
First Name:KERI
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 CHADWICK LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8962
Mailing Address - Country:US
Mailing Address - Phone:334-277-6690
Mailing Address - Fax:334-277-6690
Practice Address - Street 1:2600 BELL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4375
Practice Address - Country:US
Practice Address - Phone:334-277-6690
Practice Address - Fax:334-277-6721
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-23249OtherBLUE CROSS BLUE SHIELD
AL515-19481OtherBLUE CROSS BLUE SHIELD
AL1422090OtherUNITED CONCORDIA
AL515-19481OtherBLUE CROSS BLUE SHIELD