Healthcare Provider Details

I. General information

NPI: 1760615835
Provider Name (Legal Business Name): JOSEPH A MILLER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CROWN POINT CT
GRASS VALLEY CA
95945-9515
US

IV. Provider business mailing address

130 CROWN POINT CT
GRASS VALLEY CA
95945-9515
US

V. Phone/Fax

Practice location:
  • Phone: 530-272-6752
  • Fax: 530-272-8662
Mailing address:
  • Phone: 530-272-6752
  • Fax: 530-272-8662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number59967
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number59967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: