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General NPI Number Information
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NPI Number | 1649599937
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Entity Type | Organization
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Legal Business Name | MARISSA L. MILLER, DDS, INC
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 100 W MAIN ST
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City | SHELBY
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State | OH
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Zip | 44875-1476
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Country | US
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Telephone | 417-342-4217
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Fax |
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Provider Business Mailing Address
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Address Line | 100 W MAIN ST
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City | SHELBY
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State | OH
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Zip | 44875-1476
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Country | US
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Telephone | 417-342-4217
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARISSA L MILLER
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Credential | DDS
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Telephone | 419-342-4217
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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 | 30.022851
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License Number State | OH
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