Provider Demographics
NPI:1962605493
Name:MILLER, ABRAHAM (DDS)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
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 1:1130 S COUNTRY CLUB DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4639
Mailing Address - Country:US
Mailing Address - Phone:720-839-1806
Mailing Address - Fax:
Practice Address - Street 1:1130 S COUNTRY CLUB DR STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4639
Practice Address - Country:US
Practice Address - Phone:480-461-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9422122300000X
AZ8180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist