Healthcare Provider Details

I. General information

NPI: 1972712768
Provider Name (Legal Business Name): WILLIAM W. KENDALL MILLER III D.D.S., M.S., P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: W. KENDALL MILLER D.D.S., M.S., P.A.

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 RITCHIE HWY
SEVERNA PARK MD
21146-3919
US

IV. Provider business mailing address

690 RITCHIE HWY
SEVERNA PARK MD
21146-3919
US

V. Phone/Fax

Practice location:
  • Phone: 410-647-0800
  • Fax: 410-544-3652
Mailing address:
  • Phone: 410-647-0800
  • Fax: 410-544-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12006
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: