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General NPI Number Information
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NPI Number | 1912332016
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Entity Type | Organization
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Legal Business Name | SHELLY MILERA, DDS, INC
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Dates
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Enumeration Date | 09/08/2013
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Last Update Date | 09/08/2013
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Provider Practice Location Address
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Address Line | 9230 BRUCEVILLE RD STE 3
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City | ELK GROVE
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State | CA
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Zip | 95758-5996
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Country | US
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Telephone | 916-538-9446
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Fax |
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Provider Business Mailing Address
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Address Line | 9230 BRUCEVILLE RD STE 3
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City | ELK GROVE
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State | CA
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Zip | 95758-5996
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Country | US
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Telephone | 916-538-9446
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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. SHELLY A MILERA
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Credential | D.M.D
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Telephone | 916-538-9446
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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 | 55902
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License Number State | CA
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