Provider Demographics
NPI:1932293610
Name:MILLER, JIMMIE D II (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:D
Last Name:MILLER
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9090 SKILLMAN ST.
Mailing Address - Street 2:#283A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243
Mailing Address - Country:US
Mailing Address - Phone:214-340-2111
Mailing Address - Fax:214-348-2589
Practice Address - Street 1:9090 SKILLMAN ST.
Practice Address - Street 2:#283A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:214-340-2111
Practice Address - Fax:214-348-2589
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice