Provider Demographics
NPI:1710196506
Name:MILLER, LISA (DMD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
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 1:301 W LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-1920
Mailing Address - Country:US
Mailing Address - Phone:251-320-3205
Mailing Address - Fax:251-320-3204
Practice Address - Street 1:301 W LAUREL AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1920
Practice Address - Country:US
Practice Address - Phone:251-320-3205
Practice Address - Fax:251-320-3204
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD53641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery