Provider Demographics
NPI:1780942144
Name:MILLER, MARCUS ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:ROBERT
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 1:1515 ARGONNE LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-7884
Mailing Address - Country:US
Mailing Address - Phone:651-431-1045
Mailing Address - Fax:
Practice Address - Street 1:2151 FOUNTAIN DR STE 206
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6753
Practice Address - Country:US
Practice Address - Phone:770-696-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0159671223E0200X
WA602886541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice