Provider Demographics
NPI:1760615835
Name:MILLER, JOSEPH A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
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 1:130 CROWN POINT CT
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9515
Mailing Address - Country:US
Mailing Address - Phone:530-272-6752
Mailing Address - Fax:530-272-8662
Practice Address - Street 1:130 CROWN POINT CT
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9515
Practice Address - Country:US
Practice Address - Phone:530-272-6752
Practice Address - Fax:530-272-8662
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59967122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist