Provider Demographics
NPI:1851370324
Name:MILLER, NICOLLE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLLE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10513 LA MIRADA BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-1443
Mailing Address - Country:US
Mailing Address - Phone:562-652-8582
Mailing Address - Fax:
Practice Address - Street 1:250 MAKALAPA DR
Practice Address - Street 2:COMPACFLT HEALTH SERVICES (N01HD)
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860-3131
Practice Address - Country:US
Practice Address - Phone:619-556-3917
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice