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General NPI Number Information
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NPI Number | 1689119414
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Entity Type | Organization
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Legal Business Name | JACOB S MILLER, DDS, PLLC
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 2730 5 MILE RD NE SUITE #101
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-6518
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Country | US
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Telephone | 616-364-7039
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Fax | 616-364-6068
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Provider Business Mailing Address
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Address Line | 6689 GRAN VIA DR NE
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City | ROCKFORD
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State | MI
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Zip | 49341-9689
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Country | US
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Telephone | 616-901-9148
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACOB S MILLER
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Credential | DDS
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Telephone | 616-901-9148
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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 | L2901020673
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License Number State | MI
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