Healthcare Provider Details

I. General information

NPI: 1598629420
Provider Name (Legal Business Name): KRISTEN MILLER CDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S CLINTON ST
IOWA CITY IA
52240-4105
US

IV. Provider business mailing address

400 S CLINTON ST
IOWA CITY IA
52240-4105
US

V. Phone/Fax

Practice location:
  • Phone: 319-358-4825
  • Fax:
Mailing address:
  • Phone: 319-358-4825
  • Fax: 319-688-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberQDA-08114
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: