Provider Demographics
NPI:1720143308
Name:MILLER, KEVIN EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:EDWARD
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 1:505 N SANDERS ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4528
Mailing Address - Country:US
Mailing Address - Phone:406-442-1130
Mailing Address - Fax:406-443-2339
Practice Address - Street 1:505 N SANDERS ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4528
Practice Address - Country:US
Practice Address - Phone:406-442-1130
Practice Address - Fax:406-443-2339
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice