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General NPI Number Information
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NPI Number | 1619251014
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Entity Type | Organization
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Legal Business Name | TOM J MILLER DDS PC
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 231 S GARY AVE #107
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2234
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Country | US
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Telephone | 630-980-4988
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Fax | 630-980-1375
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Provider Business Mailing Address
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Address Line | 150 S BLOOMINGDALE RD #200
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1493
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Country | US
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Telephone | 630-980-4988
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Fax | 630-980-1375
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Authorized Official
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Title or Position | DENTIST
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Name | DR. TOM JOSEPH MILLER
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Credential | DDS
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Telephone | 630-980-4988
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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 | 019019146
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License Number State | IL
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