Healthcare Provider Details

I. General information

NPI: 1063697183
Provider Name (Legal Business Name): SHELLY ANN MILERA D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8231 E STOCKTON BLVD STE C
SACRAMENTO CA
95828-8202
US

IV. Provider business mailing address

8231 E STOCKTON BLVD STE C
SACRAMENTO CA
95828-8202
US

V. Phone/Fax

Practice location:
  • Phone: 916-737-5573
  • Fax: 916-405-6342
Mailing address:
  • Phone: 916-737-5573
  • Fax: 916-405-6342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number55902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: