Provider Demographics
NPI:1952385338
Name:MILLER, ESTILL L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ESTILL
Middle Name:L
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 1:1213 W G ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2824
Mailing Address - Country:US
Mailing Address - Phone:423-543-2755
Mailing Address - Fax:423-543-7717
Practice Address - Street 1:1213 W G ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2824
Practice Address - Country:US
Practice Address - Phone:423-543-2755
Practice Address - Fax:423-543-7717
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS31801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice