Provider Demographics
NPI:1194749127
Name:MILLER, MARC A (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
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 1:645 W GOLF RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2462
Mailing Address - Country:US
Mailing Address - Phone:847-640-0778
Mailing Address - Fax:847-640-2599
Practice Address - Street 1:645 W GOLF RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2462
Practice Address - Country:US
Practice Address - Phone:847-640-0778
Practice Address - Fax:847-640-2599
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice