Provider Demographics
NPI:1649327644
Name:MILLER, EDWARD J JR (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:121 E 60TH ST
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1117
Mailing Address - Country:US
Mailing Address - Phone:212-838-5895
Mailing Address - Fax:212-838-6007
Practice Address - Street 1:121 E 60TH ST
Practice Address - Street 2:SUITE 7A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1117
Practice Address - Country:US
Practice Address - Phone:212-838-5895
Practice Address - Fax:212-838-6007
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0446711223S0112X
NY004671204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery