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General NPI Number Information
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NPI Number | 1487631297
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Entity Type | Individual
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Provider Name | JOEL SIMON MILLER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 1100 N COLLEGE AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1944
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Country | US
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Telephone | 661-257-5858
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Fax | 661-257-3660
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Provider Business Mailing Address
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Address Line | PO BOX 2429
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City | SMYRNA
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State | TN
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Zip | 37167-1719
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Country | US
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Telephone | 661-257-5858
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Fax | 661-257-3660
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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 | 32365
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License Number State | CA
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