Healthcare Provider Details

I. General information

NPI: 1053447482
Provider Name (Legal Business Name): DAVID G. MILLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 EAGLE RIDGE DR
HURON OH
44839-1868
US

IV. Provider business mailing address

1017 EAGLE RIDGE DR
HURON OH
44839-1868
US

V. Phone/Fax

Practice location:
  • Phone: 419-433-6981
  • Fax:
Mailing address:
  • Phone: 419-433-6981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.014360
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: