Provider Demographics
NPI:1104993294
Name:MILLER, TODD A (DDS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
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 1:215 OAK GROVE ST
Mailing Address - Street 2:APT. 1301
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3342
Mailing Address - Country:US
Mailing Address - Phone:612-338-5557
Mailing Address - Fax:612-373-0602
Practice Address - Street 1:510 MARQUETTE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-1110
Practice Address - Country:US
Practice Address - Phone:612-338-5557
Practice Address - Fax:612-373-0602
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND121411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice