Healthcare Provider Details

I. General information

NPI: 1629239215
Provider Name (Legal Business Name): JEFFREY PAUL MILLER DMD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

129D BRITTANY FARMS RD # D
NEW BRITAIN CT
06053-1145
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3004
  • Fax:
Mailing address:
  • Phone: 724-679-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS037182
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: