Healthcare Provider Details

I. General information

NPI: 1598850018
Provider Name (Legal Business Name): SUSAN LEE STRATTON-MILLER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 NW CIVIC DRIVE
GRESHAM OR
97030
US

IV. Provider business mailing address

1282 NW CIVIC DRIVE
GRESHAM OR
97030
US

V. Phone/Fax

Practice location:
  • Phone: 503-661-9696
  • Fax: 503-492-2727
Mailing address:
  • Phone: 503-661-9696
  • Fax: 503-492-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6784
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: