Healthcare Provider Details

I. General information

NPI: 1720436314
Provider Name (Legal Business Name): DANIEL MILLER D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S PEARSALL LANE UNIT B
HAMPSTEAD NC
28443
US

IV. Provider business mailing address

22 S PEARSALL LANE UNIT B
HAMPSTEAD NC
28443
US

V. Phone/Fax

Practice location:
  • Phone: 910-406-0787
  • Fax:
Mailing address:
  • Phone: 910-406-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10261
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: