Healthcare Provider Details

I. General information

NPI: 1366557589
Provider Name (Legal Business Name): JEFFREY C MILLER DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 FREDERICK RD 2ND FLOOR
CATONSVILLE MD
21228
US

IV. Provider business mailing address

606 FREDERICK RD 2ND FLOOR
BALTIMORE MD
21228
US

V. Phone/Fax

Practice location:
  • Phone: 410-744-2230
  • Fax: 410-744-2230
Mailing address:
  • Phone: 410-744-2230
  • Fax: 410-744-7132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberMD08085
License Number StateMD

VIII. Authorized Official

Name: MRS. ETHEL M SEIDMAN
Title or Position: COMPTROLLER
Credential:
Phone: 410-744-2230