Provider Demographics
NPI:1871700062
Name:MILLER, JAMES EDGAR III (DMD, PC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDGAR
Last Name:MILLER
Suffix:III
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 S HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1066
Mailing Address - Country:US
Mailing Address - Phone:303-237-1764
Mailing Address - Fax:
Practice Address - Street 1:2290 KIPLING ST
Practice Address - Street 2:UNIT 2
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1578
Practice Address - Country:US
Practice Address - Phone:303-232-1327
Practice Address - Fax:303-232-6154
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO07591223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics