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General NPI Number Information
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NPI Number | 1881813772
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Entity Type | Organization
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Legal Business Name | WILLIAM B MILLER DMD PC
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 05/28/2015
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Provider Practice Location Address
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Address Line | 104 OLD MILL RD
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City | LAGRANGE
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State | GA
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Zip | 30241-6704
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Country | US
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Telephone | 706-884-0049
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Fax | 706-884-2634
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Provider Business Mailing Address
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Address Line | 104 OLD MILL RD
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City | LAGRANGE
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State | GA
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Zip | 30241-6704
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Country | US
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Telephone | 706-884-0049
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Fax | 706-884-2634
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. WILLIAM BRUCE MILLER
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Credential | D.M.D.
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Telephone | 706-884-0049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN009183
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License Number State | GA
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