Provider Demographics
NPI:1811221575
Name:MILLER, KATHERINE M (DMD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:995 BEAVER GRADE RD
Mailing Address - Street 2:SUITE A2
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2766
Mailing Address - Country:US
Mailing Address - Phone:724-622-3699
Mailing Address - Fax:412-262-3966
Practice Address - Street 1:995 BEAVER GRADE RD
Practice Address - Street 2:SUITE A2
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2766
Practice Address - Country:US
Practice Address - Phone:724-622-3699
Practice Address - Fax:412-262-3966
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0380221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024057260002Medicaid