Provider Demographics
NPI:1205083920
Name:MILLER, MICHAEL BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRUCE
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 1:11757 KATY FWY
Mailing Address - Street 2:#210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1733
Mailing Address - Country:US
Mailing Address - Phone:281-493-4105
Mailing Address - Fax:
Practice Address - Street 1:11757 KATY FWY
Practice Address - Street 2:#210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1733
Practice Address - Country:US
Practice Address - Phone:281-493-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice