Provider Demographics
NPI:1508059759
Name:MILLER, TAMARA S (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:S
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 1:1850 KELLER PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3706
Mailing Address - Country:US
Mailing Address - Phone:817-431-1115
Mailing Address - Fax:817-431-1153
Practice Address - Street 1:1850 KELLER PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3706
Practice Address - Country:US
Practice Address - Phone:817-431-1115
Practice Address - Fax:817-431-1153
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX185891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics