Healthcare Provider Details

I. General information

NPI: 1912370115
Provider Name (Legal Business Name): JEFFREY MILLER D.D.S, P.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 FREDERICK RD
CATONSVILLE MD
21228-4856
US

IV. Provider business mailing address

606 FREDERICK ROAD
CATONSVILLE MD
21228
US

V. Phone/Fax

Practice location:
  • Phone: 410-744-2230
  • Fax: 410-744-7132
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:
Title or Position:
Credential:
Phone: