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General NPI Number Information
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NPI Number | 1467943019
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Entity Type | Individual
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Provider Name | MARY LABORDE MILLER DDS
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Gender | Female
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 2425 33RD AVE W
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City | SEATTLE
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State | WA
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Zip | 98199-3255
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Country | US
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Telephone | 206-283-7844
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Fax |
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Provider Business Mailing Address
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Address Line | 303 SHELL BEACH DR
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5825
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Country | US
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Telephone | 337-377-6020
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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 | 6856
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License Number State | LA
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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 | 60949816
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License Number State | WA
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