Provider Demographics
NPI:1285746347
Name:MILLER, DENNIS RAYMOND (DMD MS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RAYMOND
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 E 30TH ST
Mailing Address - Street 2:BLDG 1
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-8986
Mailing Address - Country:US
Mailing Address - Phone:505-326-6567
Mailing Address - Fax:
Practice Address - Street 1:2401 E 30TH ST
Practice Address - Street 2:BLDG 1
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8986
Practice Address - Country:US
Practice Address - Phone:505-326-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD19871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics