Healthcare Provider Details

I. General information

NPI: 1962502971
Provider Name (Legal Business Name): STEPHEN A MILLER DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 COURT ST
KEENE NH
03431
US

IV. Provider business mailing address

55 COURT ST
KEENE NH
03431
US

V. Phone/Fax

Practice location:
  • Phone: 603-355-1014
  • Fax: 603-352-6097
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1124
License Number StateNH

VIII. Authorized Official

Name: DR. STEPHEN A MILLER
Title or Position: PRES TREAS
Credential: DMD
Phone: 603-355-1014