Healthcare Provider Details

I. General information

NPI: 1124389507
Provider Name (Legal Business Name): TREVOR EARL MILLER D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2012
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 LINCOLN STREET 2ND FLOOR
TACOMA WA
98431
US

IV. Provider business mailing address

9900 LINCOLN STREET 2ND FLOOR
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN19960
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number19960
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: