Provider Demographics
NPI:1154492627
Name:MILLER, DENNIS KEITH (D,D,S,)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:KEITH
Last Name:MILLER
Suffix:
Gender:M
Credentials:D,D,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24001 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2555
Mailing Address - Country:US
Mailing Address - Phone:248-474-8060
Mailing Address - Fax:
Practice Address - Street 1:24001 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 160
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-2555
Practice Address - Country:US
Practice Address - Phone:248-474-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0122741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice