Provider Demographics
NPI:1881988822
Name:MILLER, DARCIANNE MARIE (DDS)
Entity type:Individual
Prefix:
First Name:DARCIANNE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 BENJAMIN AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3793
Mailing Address - Country:US
Mailing Address - Phone:248-797-7193
Mailing Address - Fax:
Practice Address - Street 1:300 E LONG LAKE RD
Practice Address - Street 2:SUITE 311
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2374
Practice Address - Country:US
Practice Address - Phone:248-203-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020436122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist