Provider Demographics
NPI:1750547774
Name:MILLER, JONATHAN MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MATTHEW
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 1:112 W SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-4317
Mailing Address - Country:US
Mailing Address - Phone:252-823-3864
Mailing Address - Fax:252-823-5864
Practice Address - Street 1:112 W SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-4317
Practice Address - Country:US
Practice Address - Phone:252-823-3864
Practice Address - Fax:252-823-5864
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice