Healthcare Provider Details

I. General information

NPI: 1407173883
Provider Name (Legal Business Name): CLAYTON JAMES MILLER D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MAITLAND AVE SUITE 1013
ALTAMONTE SPRINGS FL
32701-4903
US

IV. Provider business mailing address

201 MAITLAND AVE SUITE 1013
ALTAMONTE SPRINGS FL
32701-4903
US

V. Phone/Fax

Practice location:
  • Phone: 407-834-0330
  • Fax:
Mailing address:
  • Phone: 407-834-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 21067
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: