Provider Demographics
NPI:1992233084
Name:MILLER, HEATHER MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1221
Mailing Address - Country:US
Mailing Address - Phone:847-328-8500
Mailing Address - Fax:
Practice Address - Street 1:2805 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1221
Practice Address - Country:US
Practice Address - Phone:847-328-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012695A122300000X
IN12022695A1223G0001X
IL019032527122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice