=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750943429
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRYSTEN DIANE MILLER DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2019
-----------------------------------------------------
Last Update Date | 04/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3110 HIGHLAND RD STE 202
-----------------------------------------------------
City | HERMITAGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16148-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-981-0521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3110 HIGHLAND RD STE 202
-----------------------------------------------------
City | HERMITAGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16148-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-708-6123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS043067
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------