Provider Demographics
NPI:1316024557
Name:DONNA J MILLER DMD DANIEL F GREEN DDS & JEREMY D CRABTREE DDS INC
Entity type:Organization
Organization Name:DONNA J MILLER DMD DANIEL F GREEN DDS & JEREMY D CRABTREE DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-773-4066
Mailing Address - Street 1:345 E MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640
Mailing Address - Country:US
Mailing Address - Phone:740-288-0208
Mailing Address - Fax:740-288-9878
Practice Address - Street 1:345 E MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640
Practice Address - Country:US
Practice Address - Phone:740-288-0208
Practice Address - Fax:740-288-9878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental