Healthcare Provider Details

I. General information

NPI: 1124896618
Provider Name (Legal Business Name): MICHAEL V. MILLER, DDS,PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 PLAINFIELD AVE NE STE B
GRAND RAPIDS MI
49505-3700
US

IV. Provider business mailing address

2501 PLAINFIELD AVE NE STE B
GRAND RAPIDS MI
49505-3700
US

V. Phone/Fax

Practice location:
  • Phone: 616-363-6612
  • Fax: 616-363-3014
Mailing address:
  • Phone: 616-363-6612
  • Fax: 616-363-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL VINCENT MILLER
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 616-363-6612