Provider Demographics
NPI:1609566140
Name:MILLER, KAMRYN ALEXIS
Entity type:Individual
Prefix:
First Name:KAMRYN
Middle Name:ALEXIS
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 E LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16929-8801
Mailing Address - Country:US
Mailing Address - Phone:570-827-0145
Mailing Address - Fax:
Practice Address - Street 1:34 E LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:PA
Practice Address - Zip Code:16929-8801
Practice Address - Country:US
Practice Address - Phone:570-827-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH075182124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist