Provider Demographics
NPI:1891177200
Name:CLINTON S. MILLER P.C.
Entity Type:Organization
Organization Name:CLINTON S. MILLER P.C.
Other - Org Name:MILLER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:701-252-1661
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:701-252-1228
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:701-252-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2227122300000X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Multi-Specialty