Provider Demographics
NPI:1922203967
Name:MILLER, SHAWN LAWRENCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:LAWRENCE
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1110 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2139
Mailing Address - Country:US
Mailing Address - Phone:714-639-1061
Mailing Address - Fax:714-639-3184
Practice Address - Street 1:1110 E CHAPMAN AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2139
Practice Address - Country:US
Practice Address - Phone:714-639-1061
Practice Address - Fax:714-639-3184
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics