Provider Demographics
NPI:1427718741
Name:MILLER FAMILY DENTISTRY & IMPLANTS
Entity type:Organization
Organization Name:MILLER FAMILY DENTISTRY & IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-842-7140
Mailing Address - Street 1:301 NW 11TH ST STE 215
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-1269
Mailing Address - Country:US
Mailing Address - Phone:618-842-7140
Mailing Address - Fax:618-842-4028
Practice Address - Street 1:301 NW 11TH ST STE 215
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-1269
Practice Address - Country:US
Practice Address - Phone:618-842-7140
Practice Address - Fax:618-842-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty