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General NPI Number Information
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NPI Number | 1508407750
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Entity Type | Organization
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Legal Business Name | MILLER DENTAL GROUP
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 09/30/2019
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Provider Practice Location Address
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Address Line | 7219 RADIO RD
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City | NAPLES
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State | FL
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Zip | 34104-6707
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Country | US
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Telephone | 239-455-1018
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Fax | 239-455-2464
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Provider Business Mailing Address
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Address Line | 7219 RADIO RD
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City | NAPLES
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State | FL
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Zip | 34104-6707
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Country | US
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Telephone | 239-455-1018
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Fax | 239-455-2464
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Authorized Official
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Title or Position | OWNER
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Name | MR. ADRIANA GABALDON
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Credential | DDS
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Telephone | 239-455-1018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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