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General NPI Number Information
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NPI Number | 1679708572
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Entity Type | Organization
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Legal Business Name | MILLER DENTISTRY LLC
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 404 RANDALL ROAD
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City | SOUTH ELGIN
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State | IL
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Zip | 60177
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Country | US
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Telephone | 312-343-2934
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Fax |
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Provider Business Mailing Address
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Address Line | 1445 W BELDEN AVE UNIT 1 B
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City | CHICAGO
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State | IL
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Zip | 60614-3070
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Country | US
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Telephone | 312-343-2934
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. ANGELA MARIE MILLER
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Credential | D.D.S.
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Telephone | 312-343-2934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019025803
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License Number State | IL
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