Provider Demographics
NPI:1215487228
Name:MILLER, EMILY ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 45TH ST S
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3246
Mailing Address - Country:US
Mailing Address - Phone:701-282-2287
Mailing Address - Fax:701-282-2572
Practice Address - Street 1:510 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:MN
Practice Address - Zip Code:56549
Practice Address - Country:US
Practice Address - Phone:218-483-1038
Practice Address - Fax:701-282-2572
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2305122300000X
MND148141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist