Provider Demographics
NPI:1689989949
Name:MILLER, TIMOTHY T JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:T
Last Name:MILLER
Suffix:JR
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 1:1526 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1852
Mailing Address - Country:US
Mailing Address - Phone:415-453-6409
Mailing Address - Fax:415-453-1598
Practice Address - Street 1:1526 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1852
Practice Address - Country:US
Practice Address - Phone:415-453-6409
Practice Address - Fax:415-453-1598
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist