Provider Demographics
NPI:1245964808
Name:MILLER, ALYSON JEANINE (DDS)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:JEANINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8327
Mailing Address - Country:US
Mailing Address - Phone:956-686-5511
Mailing Address - Fax:956-686-9955
Practice Address - Street 1:2702 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8327
Practice Address - Country:US
Practice Address - Phone:956-686-5511
Practice Address - Fax:956-686-9955
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX385231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program