Provider Demographics
NPI:1356317465
Name:MILLER, JEFFERY L (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:L
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:PO BOX 749625
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-4561
Practice Address - Country:US
Practice Address - Phone:919-550-5251
Practice Address - Fax:888-981-3708
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99771223G0001X
NC96891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008447701Medicaid
TX840007OtherUNITED CONCORDIA
CADELTA DENTALOtherDELTA DENTAL