Healthcare Provider Details

I. General information

NPI: 1881813772
Provider Name (Legal Business Name): WILLIAM B MILLER DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 OLD MILL RD
LAGRANGE GA
30241-6704
US

IV. Provider business mailing address

104 OLD MILL RD
LAGRANGE GA
30241-6704
US

V. Phone/Fax

Practice location:
  • Phone: 706-884-0049
  • Fax: 706-884-2634
Mailing address:
  • Phone: 706-884-0049
  • Fax: 706-884-2634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN009183
License Number StateGA

VIII. Authorized Official

Name: DR. WILLIAM BRUCE MILLER
Title or Position: DOCTOR
Credential: D.M.D.
Phone: 706-884-0049