Provider Demographics
NPI:1215077722
Name:MILLER, ALEXANDER DENNIS (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:DENNIS
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 1:589 KNICKERBOCKER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221
Mailing Address - Country:US
Mailing Address - Phone:718-366-9191
Mailing Address - Fax:718-417-1305
Practice Address - Street 1:257 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1910
Practice Address - Country:US
Practice Address - Phone:629-224-6114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029668122300000X
ORD11198122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist