Healthcare Provider Details

I. General information

NPI: 1659638583
Provider Name (Legal Business Name): CAITLIN MARY MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S BLDG 1 DENTAL CLINIC-NORTH BRONX HEALTHCARE NETWORK
BRONX NY
10461-1119
US

IV. Provider business mailing address

5441 NEWCASTLE LN
CALABASAS CA
91302-3120
US

V. Phone/Fax

Practice location:
  • Phone: 818-653-3196
  • Fax:
Mailing address:
  • Phone: 818-653-3196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13242
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: