Healthcare Provider Details

I. General information

NPI: 1548279854
Provider Name (Legal Business Name): MR. EUGENE REINHARDT MILLER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GENE R. MILLER JR. LD.

II. Dates (important events)

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

III. Provider practice location address

14406 NE 20TH AVE KAISER, SALMON CREEK DENTAL OFFICE
VANCOUVER WA
98686-1448
US

IV. Provider business mailing address

415 N BRIDGETON RD SLIP 1
PORTLAND OR
97217-8080
US

V. Phone/Fax

Practice location:
  • Phone: 360-571-3139
  • Fax:
Mailing address:
  • Phone: 503-735-9876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN00000216
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: