Provider Demographics
NPI:1255886347
Name:MILLER, COLLIN TERREZ (DDS)
Entity type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:TERREZ
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 1:2300 AIRLINE DR
Mailing Address - Street 2:SUITE #200
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-1610
Mailing Address - Country:US
Mailing Address - Phone:318-261-9438
Mailing Address - Fax:
Practice Address - Street 1:2300 AIRLINE DR
Practice Address - Street 2:SUITE #200
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-1610
Practice Address - Country:US
Practice Address - Phone:318-261-9438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6708122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice