Provider Demographics
NPI:1952418071
Name:MILLER, THOMAS HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HENRY
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:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:BUFFALO LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55314-0096
Mailing Address - Country:US
Mailing Address - Phone:320-833-2190
Mailing Address - Fax:
Practice Address - Street 1:1801 TECHNOLOGY DRIVE NE
Practice Address - Street 2:WILLMAR REGIONALTREATMENT CENTER
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201
Practice Address - Country:US
Practice Address - Phone:320-231-5315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND72311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice