Provider Demographics
NPI:1780727453
Name:MILLER, PHILLIP GREGORY (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:GREGORY
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:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:TX
Mailing Address - Zip Code:76950-0556
Mailing Address - Country:US
Mailing Address - Phone:325-387-2659
Mailing Address - Fax:325-387-2254
Practice Address - Street 1:901 S CROCKETT AVE
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:TX
Practice Address - Zip Code:76950-7837
Practice Address - Country:US
Practice Address - Phone:325-387-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice