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General NPI Number Information
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NPI Number | 1659029270
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Entity Type | Organization
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Legal Business Name | MILLER ENDODONTIC ADVANTAGE, PLLC
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 11601 MINNETONKA MILLS RD STE C10
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City | MINNETONKA
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State | MN
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Zip | 55305-5170
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Country | US
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Telephone | 952-938-3033
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 ARGONNE LN
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City | ALPHARETTA
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State | GA
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Zip | 30004-7884
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Country | US
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Telephone | 651-431-1045
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Fax |
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. MARCUS MILLER
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Credential | DDS
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Telephone | 651-431-1045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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