Provider Demographics
NPI:1659707123
Name:MILLER, EUGENE KENNETH (DDS)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:KENNETH
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5233
Mailing Address - Country:US
Mailing Address - Phone:412-364-6364
Mailing Address - Fax:412-364-0192
Practice Address - Street 1:8135 PERRY HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5233
Practice Address - Country:US
Practice Address - Phone:412-364-6364
Practice Address - Fax:412-364-0192
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS014077L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1265656995OtherGROUP NPI NUMBER