Provider Demographics
NPI:1396421483
Name:MILLER-GNANN, MORIAH (DMD)
Entity type:Individual
Prefix:DR
First Name:MORIAH
Middle Name:
Last Name:MILLER-GNANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 E VERMIJO AVE UNIT 531
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2185
Mailing Address - Country:US
Mailing Address - Phone:614-824-8126
Mailing Address - Fax:
Practice Address - Street 1:7225 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-5802
Practice Address - Country:US
Practice Address - Phone:719-495-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002055901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice