Healthcare Provider Details

I. General information

NPI: 1215487228
Provider Name (Legal Business Name): EMILY ANN MILLER D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 07/16/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 MAIN STREET
HAWLEY MN
56549
US

IV. Provider business mailing address

1650 45TH ST S SUITE 108
FARGO ND
58103-3246
US

V. Phone/Fax

Practice location:
  • Phone: 218-483-1038
  • Fax: 701-282-2572
Mailing address:
  • Phone: 701-282-2287
  • Fax: 701-282-2572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2305
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD14814
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: