Healthcare Provider Details

I. General information

NPI: 1619923448
Provider Name (Legal Business Name): PAUL E MILLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N 30TH ST
QUINCY IL
62301-3737
US

IV. Provider business mailing address

4906 PEBBLE BEACH DR
QUINCY IL
62305-6013
US

V. Phone/Fax

Practice location:
  • Phone: 217-224-8002
  • Fax: 217-224-5703
Mailing address:
  • Phone: 217-224-8002
  • Fax: 217-224-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: