Healthcare Provider Details

I. General information

NPI: 1861539785
Provider Name (Legal Business Name): GARY WARREN MILLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E OKLAHOMA AVE SUITE 102
ENID OK
73701-5951
US

IV. Provider business mailing address

615 E OKLAHOMA SUITE 102 DR GARY W MILLER DDS
ENID OK
73701
US

V. Phone/Fax

Practice location:
  • Phone: 580-242-1500
  • Fax:
Mailing address:
  • Phone: 580-242-1500
  • Fax: 580-242-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3640
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: