Provider Demographics
NPI:1831157783
Name:MILLER, JOHN FRANKLIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANKLIN
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 1:1193 PINE TREE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-8632
Mailing Address - Country:US
Mailing Address - Phone:847-562-6319
Mailing Address - Fax:
Practice Address - Street 1:3301A 6TH ST
Practice Address - Street 2:BLDG 1017
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-0001
Practice Address - Country:US
Practice Address - Phone:847-688-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO66671223G0001X
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice