Provider Demographics
NPI:1821224577
Name:MILLER, CLINTON S (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:S
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 1:302 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4157
Mailing Address - Country:US
Mailing Address - Phone:701-252-1661
Mailing Address - Fax:
Practice Address - Street 1:302 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4157
Practice Address - Country:US
Practice Address - Phone:701-252-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7356970-99221223G0001X
ND22271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice