Healthcare Provider Details

I. General information

NPI: 1386356863
Provider Name (Legal Business Name): KATELYN C MILLER DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N MILLER DR STE A
SUNBURY OH
43074-7651
US

IV. Provider business mailing address

120 N MILLER DR STE A
SUNBURY OH
43074-7651
US

V. Phone/Fax

Practice location:
  • Phone: 740-936-3083
  • Fax: 740-936-3683
Mailing address:
  • Phone: 740-936-3083
  • Fax: 740-936-3683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. KATELYN MILLER
Title or Position: OWNER
Credential: DDS
Phone: 740-936-3083