Provider Demographics
NPI:1043483183
Name:MILLER, PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 WALT WHITMAN RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2208
Mailing Address - Country:US
Mailing Address - Phone:631-271-0390
Mailing Address - Fax:631-673-3462
Practice Address - Street 1:807 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2208
Practice Address - Country:US
Practice Address - Phone:631-271-0390
Practice Address - Fax:631-673-3462
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics