Provider Demographics
NPI:1285797167
Name:MILLER, REX F (DMD, PC)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:F
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 BLACKSTONE ALY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9007
Mailing Address - Country:US
Mailing Address - Phone:541-899-1924
Mailing Address - Fax:541-899-4441
Practice Address - Street 1:570 BLACKSTONE ALY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9007
Practice Address - Country:US
Practice Address - Phone:541-899-1924
Practice Address - Fax:541-899-4441
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR67271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice