Provider Demographics
NPI:1245723345
Name:MILLER, NATHAN ANTHONY (DMD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ANTHONY
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 WHITE PINE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-3155
Mailing Address - Country:US
Mailing Address - Phone:847-721-1667
Mailing Address - Fax:
Practice Address - Street 1:975 WHITE PINE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-3155
Practice Address - Country:US
Practice Address - Phone:847-721-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL319.0209441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice