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General NPI Number Information
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NPI Number | 1669901146
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Entity Type | Individual
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Provider Name | DREW DENNIS MILLER DMD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 06/08/2017
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Provider Practice Location Address
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Address Line | 12605 TROXLER AVE
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City | HIGHLAND
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State | IL
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Zip | 62249-1041
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Country | US
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Telephone | 618-882-6405
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Fax |
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Provider Business Mailing Address
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Address Line | 1704 E 2453RD LN
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City | CAMP POINT
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State | IL
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Zip | 62320-2111
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Country | US
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Telephone | 217-440-7175
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 319020540
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019031186
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License Number State | IL
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