Provider Demographics
NPI:1992885826
Name:MILLER, DALE EDWARD JR (DDS)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:EDWARD
Last Name:MILLER
Suffix:JR
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 1:307 SOUTH 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3256
Mailing Address - Country:US
Mailing Address - Phone:509-248-5807
Mailing Address - Fax:509-248-5943
Practice Address - Street 1:307 SOUTH 11TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3256
Practice Address - Country:US
Practice Address - Phone:509-248-5807
Practice Address - Fax:509-248-5943
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5180807Medicaid
WA5180807Medicaid