Provider Demographics
NPI:1881812600
Name:MILLER, LANCE M (DDS)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:M
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 1:5400 N OAK TRFY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4688
Mailing Address - Country:US
Mailing Address - Phone:816-454-4450
Mailing Address - Fax:816-454-8778
Practice Address - Street 1:5400 N OAK TRFY
Practice Address - Street 2:SUITE 107
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4688
Practice Address - Country:US
Practice Address - Phone:816-454-4450
Practice Address - Fax:816-454-8778
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO152881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO18102-011OtherBCBS