Provider Demographics
NPI:1770196446
Name:MILLER SKINNER AND DASTRUP DENTAL CORPORATION OF CHOWCHILLA
Entity Type:Organization
Organization Name:MILLER SKINNER AND DASTRUP DENTAL CORPORATION OF CHOWCHILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-452-3022
Mailing Address - Street 1:552 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2837
Mailing Address - Country:US
Mailing Address - Phone:480-452-3022
Mailing Address - Fax:
Practice Address - Street 1:345 TRINITY AVE
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-2860
Practice Address - Country:US
Practice Address - Phone:559-665-3565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental