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General NPI Number Information
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NPI Number | 1407003247
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Entity Type | Individual
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Provider Name | KEVIN MODESTO MILLER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2008
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 9871 S PARKER RD #105
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City | PARKER
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State | CO
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Zip | 80134-8802
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Country | US
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Telephone | 303-805-5703
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Fax |
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Provider Business Mailing Address
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Address Line | 11618 CALDY AVE
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City | LOMA LINDA
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State | CA
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Zip | 92354-6704
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 57229
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 00202207
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License Number State | CO
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