Healthcare Provider Details

I. General information

NPI: 1023472347
Provider Name (Legal Business Name): LAURA CHRISTINE MARTIN MILLER D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA CHRISTINE MARTIN D.M.D.

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 E MAIN ST
KENT OH
44240-2540
US

IV. Provider business mailing address

337 E MAIN ST
KENT OH
44240-2540
US

V. Phone/Fax

Practice location:
  • Phone: 330-673-9745
  • Fax: 330-677-5228
Mailing address:
  • Phone: 330-673-9745
  • Fax: 330-677-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.24786
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: