Provider Demographics
NPI:1962072058
Name:MILLER, GABRIELLE ALEXA (DDS)
Entity type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:ALEXA
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GABRIELLE
Other - Middle Name:ALEXA
Other - Last Name:SKAGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:353 COPPER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-9787
Mailing Address - Country:US
Mailing Address - Phone:304-610-9319
Mailing Address - Fax:
Practice Address - Street 1:1310 W WALNUT ST STE C
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3316
Practice Address - Country:US
Practice Address - Phone:479-636-6807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR46131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice