Provider Demographics
NPI:1124896618
Name:MICHAEL V. MILLER, DDS,PLC
Entity type:Organization
Organization Name:MICHAEL V. MILLER, DDS,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-363-6612
Mailing Address - Street 1:2501 PLAINFIELD AVE NE STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-3700
Mailing Address - Country:US
Mailing Address - Phone:616-363-6612
Mailing Address - Fax:616-363-3014
Practice Address - Street 1:2501 PLAINFIELD AVE NE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3700
Practice Address - Country:US
Practice Address - Phone:616-363-6612
Practice Address - Fax:616-363-3014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty