Provider Demographics
NPI:1730121906
Name:MILLER, BRIAN D (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
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 1:8 W MARKET ST
Mailing Address - Street 2:STE 1150
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1899
Mailing Address - Country:US
Mailing Address - Phone:570-825-7583
Mailing Address - Fax:570-825-9887
Practice Address - Street 1:8 W MARKET ST
Practice Address - Street 2:STE 1150
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1899
Practice Address - Country:US
Practice Address - Phone:570-825-7583
Practice Address - Fax:570-825-9887
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA357561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics