Healthcare Provider Details

I. General information

NPI: 1922809128
Provider Name (Legal Business Name): SHAWN L. MILLER, DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 E CHAPMAN AVE STE 205
ORANGE CA
92866-2147
US

IV. Provider business mailing address

1110 E CHAPMAN AVE STE 205
ORANGE CA
92866-2147
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-1061
  • Fax: 714-639-3184
Mailing address:
  • Phone: 714-639-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAWN LAWRENCE MILLER
Title or Position: OWNER/PRESIDENT
Credential: DMD
Phone: 714-878-5783