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General NPI Number Information
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NPI Number | 1942351606
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Entity Type | Organization
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Legal Business Name | STANLEY MILLER DDS, PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 6350 W RAMSEY ST SUITE #A
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City | BANNING
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State | CA
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Zip | 92220-3062
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Country | US
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Telephone | 951-769-0466
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Fax | 951-769-3606
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Provider Business Mailing Address
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Address Line | 6350 W RAMSEY ST SUITE #A
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City | BANNING
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State | CA
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Zip | 92220-3062
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Country | US
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Telephone | 951-769-0466
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Fax | 951-769-3606
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STANLEY KELLY MILLER
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Credential | D.D.S.
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Telephone | 951-769-0466
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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 | 43640
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License Number State | CA
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