Provider Demographics
NPI:1104293877
Name:MILLER, NATHAN KING (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:KING
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 1:2813 FIDDLEBACK ST NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-4426
Mailing Address - Country:US
Mailing Address - Phone:316-393-4493
Mailing Address - Fax:
Practice Address - Street 1:21610 PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:OCEAN PARK
Practice Address - State:WA
Practice Address - Zip Code:98640-3206
Practice Address - Country:US
Practice Address - Phone:360-665-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015018855122300000X
WADE609383771223G0001X
WA609383771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist