Healthcare Provider Details

I. General information

NPI: 1013151521
Provider Name (Legal Business Name): DEREK ALLAN MILLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 05/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 TUTT BLVD SUITE 140
COLORADO SPRINGS CO
80923-3500
US

IV. Provider business mailing address

6160 TUTT BLVD SUITE 140
COLORADO SPRINGS CO
80923-3500
US

V. Phone/Fax

Practice location:
  • Phone: 719-550-1010
  • Fax: 719-550-1212
Mailing address:
  • Phone: 719-550-1010
  • Fax: 719-550-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9841
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: