Provider Demographics
NPI:1750694592
Name:MILLER, CATHERINE L (DMD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10022 SW 70TH PL
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-1191
Mailing Address - Country:US
Mailing Address - Phone:702-371-5990
Mailing Address - Fax:
Practice Address - Street 1:7417 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:SUITE 700
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-2169
Practice Address - Country:US
Practice Address - Phone:503-719-7518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 601548791223X0400X
ORD93651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics