Provider Demographics
NPI:1891127866
Name:MILLERY, ELYCE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELYCE
Middle Name:D
Last Name:MILLERY
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 1:7581 BUCKINGHAM BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-3182
Mailing Address - Country:US
Mailing Address - Phone:443-863-2273
Mailing Address - Fax:443-863-7111
Practice Address - Street 1:7581 BUCKINGHAM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076
Practice Address - Country:US
Practice Address - Phone:443-863-2273
Practice Address - Fax:443-863-7111
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD154811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD071082200Medicaid