Provider Demographics
NPI:1902177488
Name:MILLER, DARLENE KAY (RDH)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:KAY
Last Name:MILLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68765 SCOFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-9101
Mailing Address - Country:US
Mailing Address - Phone:541-923-8331
Mailing Address - Fax:
Practice Address - Street 1:68765 SCOFIELD RD
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-9101
Practice Address - Country:US
Practice Address - Phone:541-923-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH2724124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist