Provider Demographics
NPI:1710043674
Name:MILLER, GEORGE KEITH (DMD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:KEITH
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9464 CIVIC CENTRE BOULEVARD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-777-7883
Mailing Address - Fax:513-755-1604
Practice Address - Street 1:9464 CIVIC CENTRE BOULEVARD
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-9998
Practice Address - Country:US
Practice Address - Phone:513-777-7883
Practice Address - Fax:513-755-1604
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020011122300000X
KY5935122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist