Healthcare Provider Details

I. General information

NPI: 1942311709
Provider Name (Legal Business Name): CANDACE J MILLER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 VALE TERRACE DR
VISTA CA
92084-5218
US

IV. Provider business mailing address

1000 VALE TERRACE DR
VISTA CA
92084-5218
US

V. Phone/Fax

Practice location:
  • Phone: 760-407-1220
  • Fax: 760-414-3702
Mailing address:
  • Phone: 760-631-5000
  • Fax: 760-414-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number27035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: