Provider Demographics
NPI:1336554864
Name:MILLER, MITCHELL (DDS)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 N CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3415
Mailing Address - Country:US
Mailing Address - Phone:561-336-6560
Mailing Address - Fax:
Practice Address - Street 1:391 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3415
Practice Address - Country:US
Practice Address - Phone:561-336-6560
Practice Address - Fax:561-336-6560
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21113122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist