Healthcare Provider Details

I. General information

NPI: 1407933641
Provider Name (Legal Business Name): DONNA J MILLER DMD DANIEL F GREEN DDS AND JEREMY D CRABTREE DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 EXECUTIVE CENTER DR
CHILLICOTHEE OH
45601
US

IV. Provider business mailing address

PO BOX 1007
CHILLICOTHEE OH
45601
US

V. Phone/Fax

Practice location:
  • Phone: 740-773-4066
  • Fax: 740-773-9174
Mailing address:
  • Phone: 740-773-4066
  • Fax: 740-773-9174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAN GREEN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 740-773-4066