Provider Demographics
NPI:1740425347
Name:MILLER, MARIANNE D
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:D
Other - Last Name:MOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2050 TILDEN AVE
Mailing Address - Street 2:BOX 1000
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-3613
Mailing Address - Country:US
Mailing Address - Phone:315-797-3114
Mailing Address - Fax:315-624-0474
Practice Address - Street 1:2050 TILDEN AVE
Practice Address - Street 2:BOX 1000
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-3613
Practice Address - Country:US
Practice Address - Phone:315-797-3114
Practice Address - Fax:315-624-0474
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023915124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474180Medicaid
NY334526Medicaid
NY335475Medicaid
NY01815443Medicare Oscar/Certification
NY335475Medicaid