Provider Demographics
NPI:1851744940
Name:SUSAN S. MILLER, DDS. PLLC
Entity Type:Organization
Organization Name:SUSAN S. MILLER, DDS. PLLC
Other - Org Name:MAPLE LEAF DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-402-3402
Mailing Address - Street 1:7750 15TH AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4313
Mailing Address - Country:US
Mailing Address - Phone:206-402-3402
Mailing Address - Fax:206-402-3460
Practice Address - Street 1:7750 15TH AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4313
Practice Address - Country:US
Practice Address - Phone:206-402-3402
Practice Address - Fax:206-402-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006218122300000X
WADE00003086122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty