Provider Demographics
NPI:1740567288
Name:MILLER, DEAN R (LMT)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:R
Last Name:MILLER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-7639
Mailing Address - Country:US
Mailing Address - Phone:503-738-0612
Mailing Address - Fax:
Practice Address - Street 1:925 AVENUE H
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-7639
Practice Address - Country:US
Practice Address - Phone:503-738-0612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11981171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor