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General NPI Number Information
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NPI Number | 1609202357
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Entity Type | Organization
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Legal Business Name | MILLER AND ASSOCIATES FIVE LLC
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Dates
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Enumeration Date | 09/25/2013
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Last Update Date | 09/25/2013
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Provider Practice Location Address
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Address Line | 1602 HIGHWAY 17 N
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City | SURFSIDE BEACH
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State | SC
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Zip | 29575-6015
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Country | US
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Telephone | 843-238-3332
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Fax |
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Provider Business Mailing Address
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Address Line | 1602 HIGHWAY 17 N
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City | SURFSIDE BEACH
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State | SC
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Zip | 29575-6015
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Country | US
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Telephone | 843-238-3332
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT BAILEY MILLER IV
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Credential | DDS
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Telephone | 252-626-9729
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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 | 7519
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License Number State | NC
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