Healthcare Provider Details

I. General information

NPI: 1669734018
Provider Name (Legal Business Name): DAVID L. MILLER, D,D.S., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 HERITAGE PKWY SUITE 120
ROCKWALL TX
75087-8799
US

IV. Provider business mailing address

6701 HERITAGE PKWY SUITE 120
ROCKWALL TX
75087-8799
US

V. Phone/Fax

Practice location:
  • Phone: 972-412-5857
  • Fax: 972-412-5851
Mailing address:
  • Phone: 972-412-5857
  • Fax: 972-412-5851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number15066
License Number StateTX

VIII. Authorized Official

Name: DR. DAVID L. MILLER
Title or Position: OWNER
Credential: D.D.S.
Phone: 972-412-5857