Healthcare Provider Details

I. General information

NPI: 1558312058
Provider Name (Legal Business Name): MICHAEL E MILLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10124 W BROAD ST SUITE A
GLEN ALLEN VA
23060-3330
US

IV. Provider business mailing address

PO BOX 71930
RICHMOND VA
23255-1930
US

V. Phone/Fax

Practice location:
  • Phone: 804-354-1600
  • Fax: 804-354-1607
Mailing address:
  • Phone: 804-354-1600
  • Fax: 804-354-1607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401007045
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: