Provider Demographics
NPI:1750943429
Name:MILLER, KRYSTEN DIANE (DMD)
Entity type:Individual
Prefix:DR
First Name:KRYSTEN
Middle Name:DIANE
Last Name:MILLER
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 HIGHLAND RD STE 202
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-4505
Mailing Address - Country:US
Mailing Address - Phone:440-708-6123
Mailing Address - Fax:
Practice Address - Street 1:3110 HIGHLAND RD STE 202
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4505
Practice Address - Country:US
Practice Address - Phone:724-981-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist