Healthcare Provider Details

I. General information

NPI: 1114641354
Provider Name (Legal Business Name): ARIELLE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 09/30/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7223 MISSISSIPPI AVE DENTAC, BLDG 1561
FT POLK LA
71459
US

IV. Provider business mailing address

7223 MISSISSIPPI AVE DENTAC, BLDG 1561
FT POLK LA
71459
US

V. Phone/Fax

Practice location:
  • Phone: 337-531-2603
  • Fax:
Mailing address:
  • Phone: 337-531-2603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number108186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: