Provider Demographics
NPI:1013118561
Name:MILLER AND DIXON ORTHODONTICS LLC
Entity Type:Organization
Organization Name:MILLER AND DIXON ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MS
Authorized Official - Phone:803-327-1144
Mailing Address - Street 1:1564 CONSTITUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3004
Mailing Address - Country:US
Mailing Address - Phone:803-327-1144
Mailing Address - Fax:803-328-2100
Practice Address - Street 1:1564 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3004
Practice Address - Country:US
Practice Address - Phone:803-327-1144
Practice Address - Fax:803-328-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty