Provider Demographics
NPI:1194910661
Name:MILLER, DDS, PC
Entity type:Organization
Organization Name:MILLER, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:7349 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7221
Mailing Address - Country:US
Mailing Address - Phone:757-564-8942
Mailing Address - Fax:757-564-8667
Practice Address - Street 1:7349 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7221
Practice Address - Country:US
Practice Address - Phone:757-564-8942
Practice Address - Fax:757-564-8667
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLER, DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty