Provider Demographics
NPI:1396477543
Name:MILLER, VICTORIA LEA (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:LEA
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 1:207 FISCHER DR
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:IA
Mailing Address - Zip Code:51579-1415
Mailing Address - Country:US
Mailing Address - Phone:641-456-8150
Mailing Address - Fax:
Practice Address - Street 1:1415 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2052
Practice Address - Country:US
Practice Address - Phone:712-263-5615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-100221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice