Provider Demographics
NPI:1245310176
Name:DALE E MILLER DDS PS
Entity type:Organization
Organization Name:DALE E MILLER DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-248-5807
Mailing Address - Street 1:307 SOUTH 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3256
Mailing Address - Country:US
Mailing Address - Phone:509-248-5807
Mailing Address - Fax:509-248-5943
Practice Address - Street 1:307 SOUTH 11TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3256
Practice Address - Country:US
Practice Address - Phone:509-248-5807
Practice Address - Fax:509-248-5943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5042056Medicaid
6004052361802Medicare UPIN