Provider Demographics
NPI:1578391801
Name:JESSICA M.P. MILLER, D.D.S., LLC
Entity type:Organization
Organization Name:JESSICA M.P. MILLER, D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-829-1097
Mailing Address - Street 1:460 RONA PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-1118
Mailing Address - Country:US
Mailing Address - Phone:937-833-4411
Mailing Address - Fax:
Practice Address - Street 1:460 RONA PKWY
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-1118
Practice Address - Country:US
Practice Address - Phone:937-833-4411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental