Provider Demographics
NPI:1841410974
Name:MILLER, GLENN PAUL (DDS)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:PAUL
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 1:11550 PHILADELPHIA ROAD SUITE #118
Mailing Address - Street 2:
Mailing Address - City:WHITEMARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162
Mailing Address - Country:US
Mailing Address - Phone:410-256-4868
Mailing Address - Fax:410-256-7644
Practice Address - Street 1:11550 PHILADELPHIA ROAD SUITE #118
Practice Address - Street 2:
Practice Address - City:WHITEMARSH
Practice Address - State:MD
Practice Address - Zip Code:21162
Practice Address - Country:US
Practice Address - Phone:410-256-4868
Practice Address - Fax:410-256-7644
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6705MD122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist