Healthcare Provider Details

I. General information

NPI: 1861799652
Provider Name (Legal Business Name): STEVEN M MILLER DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12788 W FOREST HILL BLVD SUITE 2001
WELLINGTON FL
33414-4703
US

IV. Provider business mailing address

12788 W FOREST HILL BLVD SUITE 2001
WELLINGTON FL
33414-4703
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-8023
  • Fax: 561-791-8802
Mailing address:
  • Phone: 561-798-8023
  • Fax: 561-791-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10350
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberDN10350
License Number StateFL

VIII. Authorized Official

Name: DR. STEVEN M MILLER
Title or Position: OWNER
Credential: DDS
Phone: 561-798-8023