Dr. Mark D. Miller, DDS
Dentist, Oral and Maxillofacial Surgery in Louisville, KY. Individual provider (NPI-1).
NPI number1104982016
StatusActive
Last updated in NPPESJun 24, 2020
Details
- NPI
- 1104982016
- Entity type
- Individual (NPI-1)
- Name
- Dr. Mark D. Miller
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 28, 2006
- Certification date
- Jun 24, 2020
- Last updated
- Jun 24, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 6861 | KY | Yes |
| 1223D0004X | Dentist, Dentist Anesthesiologist Speciality | 6861 | KY | |
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 36087 | TX | |
| 204E00000X | Oral & Maxillofacial Surgery | 6861 | KY |
Practice location
1211 W Broadway Unit 106Louisville, KY 40203-2082
Phone 270-885-0165 · Fax 270-886-2224
Mailing address
15142 Rosario RdFrisco, TX 75035-5439
Phone 270-889-3686
Other practice locations
2400 Richmond Rd Ste 133
Texarkana, TX 75503-2464
Texarkana, TX 75503-2464
Phone 903-306-0790 · Fax 903-831-9940
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