Provider Demographics
NPI:1215956123
Name:MILLER, CARY S (DMD)
Entity type:Individual
Prefix:DR
First Name:CARY
Middle Name:S
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-5607
Mailing Address - Country:US
Mailing Address - Phone:706-754-3121
Mailing Address - Fax:706-754-2998
Practice Address - Street 1:349 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-5607
Practice Address - Country:US
Practice Address - Phone:706-754-3121
Practice Address - Fax:706-754-2998
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10813122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist