Provider Demographics
NPI:1184892010
Name:MARK D, MILLERDDSPSC
Entity type:Organization
Organization Name:MARK D, MILLERDDSPSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DELMAR
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:270-885-0165
Mailing Address - Street 1:320 COOL WATER CT
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-8738
Mailing Address - Country:US
Mailing Address - Phone:270-885-0165
Mailing Address - Fax:270-886-2224
Practice Address - Street 1:320 COOL WATER CT
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8738
Practice Address - Country:US
Practice Address - Phone:270-885-0165
Practice Address - Fax:270-886-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty