Provider Demographics
NPI:1255642906
Name:MILLER, RHIANNON MARIAH (DDS)
Entity type:Individual
Prefix:DR
First Name:RHIANNON
Middle Name:MARIAH
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 1:1303 CARROLL CREEK RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4674
Mailing Address - Country:US
Mailing Address - Phone:423-232-0747
Mailing Address - Fax:423-328-7749
Practice Address - Street 1:1303 CARROLL CREEK RD
Practice Address - Street 2:SUITE 120
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-4674
Practice Address - Country:US
Practice Address - Phone:423-232-0747
Practice Address - Fax:423-328-7749
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014128741223G0001X
TN91571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9157OtherLICENSE