Provider Demographics
NPI:1447854237
Name:MILLER PEDIATRIC DENTISTRY CORAL SPRINGS PA
Entity type:Organization
Organization Name:MILLER PEDIATRIC DENTISTRY CORAL SPRINGS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-344-0445
Mailing Address - Street 1:8150 ROYAL PALM BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5704
Mailing Address - Country:US
Mailing Address - Phone:954-344-0445
Mailing Address - Fax:954-344-2840
Practice Address - Street 1:8150 ROYAL PALM BLVD STE 104
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5704
Practice Address - Country:US
Practice Address - Phone:954-344-0445
Practice Address - Fax:954-344-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty