Provider Demographics
NPI:1821069253
Name:MILLER, DENIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2504
Mailing Address - Country:US
Mailing Address - Phone:605-335-1080
Mailing Address - Fax:605-332-4550
Practice Address - Street 1:6401 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2504
Practice Address - Country:US
Practice Address - Phone:605-335-1080
Practice Address - Fax:605-332-4550
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM9081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8000420Medicaid
SD8000420Medicaid
SDS6671Medicare PIN