Provider Demographics
NPI:1710666417
Name:MILLER, CASI ANNE
Entity Type:Individual
Prefix:
First Name:CASI
Middle Name:ANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2292 DALTON DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8960
Mailing Address - Country:US
Mailing Address - Phone:931-503-1111
Mailing Address - Fax:
Practice Address - Street 1:3724 COVES WAY
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:TN
Practice Address - Zip Code:37010-8041
Practice Address - Country:US
Practice Address - Phone:931-801-8987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000006348124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist