Provider Demographics
NPI:1447456199
Name:MILLER, KELLY NOELLE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:NOELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:NOELLE
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9800 NE 120TH PL STE C
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4220
Mailing Address - Country:US
Mailing Address - Phone:425-823-4100
Mailing Address - Fax:
Practice Address - Street 1:9800 NE 120TH PL STE C
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4220
Practice Address - Country:US
Practice Address - Phone:425-823-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57277122300000X
IL019029316122300000X
WADE604682351223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist