Provider Demographics
NPI:1639224678
Name:MILLER, JOE H (DDS FAAD)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:H
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS FAAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 FERNWOOD ROAD
Mailing Address - Street 2:#601
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:US
Mailing Address - Phone:301-897-3350
Mailing Address - Fax:301-897-5571
Practice Address - Street 1:10215 FERNWOOD
Practice Address - Street 2:#601
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-897-3350
Practice Address - Fax:301-897-5571
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD34811223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD765860Medicare ID - Type Unspecified
U49092Medicare UPIN