Provider Demographics
NPI:1891897484
Name:MILLER, GARRY MERRILL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:MERRILL
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 1:1747 PENNSYLVANIA AVE NW
Mailing Address - Street 2:SUITE G-100
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006
Mailing Address - Country:US
Mailing Address - Phone:202-298-6111
Mailing Address - Fax:202-466-2486
Practice Address - Street 1:1747 PENNSYLVANIA AVE NW
Practice Address - Street 2:SUITE G-100
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006
Practice Address - Country:US
Practice Address - Phone:202-298-6111
Practice Address - Fax:202-466-2486
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2387122300000X
MD4054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist