Provider Demographics
NPI:1538388640
Name:MILLER, E LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:E
Middle Name:LYNN
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 1:904 ELM ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4875
Mailing Address - Country:US
Mailing Address - Phone:573-443-2434
Mailing Address - Fax:
Practice Address - Street 1:904 ELM ST
Practice Address - Street 2:SUITE 214
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4875
Practice Address - Country:US
Practice Address - Phone:573-443-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO120901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice