Healthcare Provider Details

I. General information

NPI: 1336798651
Provider Name (Legal Business Name): MILLER AND SKINNER DENTAL GROUP CORPORATION OF NORTH MERCED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3071 COLLEGE GREEN DR STE C
MERCED CA
95348-3204
US

IV. Provider business mailing address

530 W 21ST ST STE B
MERCED CA
95340-3719
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-3961
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATHAN MILLER
Title or Position: OWNER
Credential: DDS
Phone: 480-452-3022