Healthcare Provider Details

I. General information

NPI: 1831183789
Provider Name (Legal Business Name): MARIA ELENA MILLER-RINALDI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HOPE DR
MOUNTAIN HOME A F B ID
83648-1062
US

IV. Provider business mailing address

1625 FAIRWAY CT
MOUNTAIN HOME ID
83647-3805
US

V. Phone/Fax

Practice location:
  • Phone: 208-828-7300
  • Fax:
Mailing address:
  • Phone: 319-594-7031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number08306
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: