Healthcare Provider Details

I. General information

NPI: 1962590448
Provider Name (Legal Business Name): DANIEL S MILLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16168 BEACH BLVD #100
HUNTINGTON BEACH CA
92647
US

IV. Provider business mailing address

16168 BEACH BLVD #100
HUNTINGTON BEACH CA
92647
US

V. Phone/Fax

Practice location:
  • Phone: 714-842-7729
  • Fax: 714-842-5968
Mailing address:
  • Phone: 714-842-7729
  • Fax: 714-842-5968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number37875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: