Healthcare Provider Details

I. General information

NPI: 1376757229
Provider Name (Legal Business Name): JACQUELINE A MILLER R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 N 7TH ST
PHOENIX AZ
85020-5300
US

IV. Provider business mailing address

5810 E LUDLOW DR
SCOTTSDALE AZ
85254-3133
US

V. Phone/Fax

Practice location:
  • Phone: 602-230-0811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH 4795
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: