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General NPI Number Information
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NPI Number | 1003027830
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Entity Type | Individual
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Provider Name | CLYDE EDWARD MILLER DDS
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9377 E BELL RD STE 301
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-1505
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Country | US
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Telephone | 480-513-2620
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Fax | 480-513-9308
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Provider Business Mailing Address
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Address Line | 9598 E SOUTHWIND LN
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City | SCOTTSDALE
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State | AZ
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Zip | 85262-3656
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Country | US
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Telephone | 480-473-0226
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D5415
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License Number State | AZ
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