Provider Demographics
NPI:1912332016
Name:SHELLY MILERA, DDS, INC
Entity Type:Organization
Organization Name:SHELLY MILERA, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-538-9446
Mailing Address - Street 1:9230 BRUCEVILLE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-5996
Mailing Address - Country:US
Mailing Address - Phone:916-538-9446
Mailing Address - Fax:
Practice Address - Street 1:9230 BRUCEVILLE RD STE 3
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5996
Practice Address - Country:US
Practice Address - Phone:916-538-9446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-08
Last Update Date:2013-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty