Provider Demographics
NPI:1689869828
Name:MILLER, MATTHEW RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RICHARD
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 1:1927 BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1821
Mailing Address - Country:US
Mailing Address - Phone:704-372-5411
Mailing Address - Fax:704-372-5414
Practice Address - Street 1:1927 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1821
Practice Address - Country:US
Practice Address - Phone:704-372-5411
Practice Address - Fax:704-372-5414
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice