Healthcare Provider Details

I. General information

NPI: 1326822784
Provider Name (Legal Business Name): MADELINE MILLER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 CLOVIS AVE STE 102
CLOVIS CA
93612-4004
US

IV. Provider business mailing address

5080 N PLEASANT AVE
FRESNO CA
93711-2709
US

V. Phone/Fax

Practice location:
  • Phone: 559-472-9978
  • Fax:
Mailing address:
  • Phone: 559-260-2084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number109214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: