Provider Demographics
NPI:1174619290
Name:MILLER, MARJORIE (DDS)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 HILLGROVE AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558
Mailing Address - Country:US
Mailing Address - Phone:708-246-3635
Mailing Address - Fax:708-246-3637
Practice Address - Street 1:518 HILLGROVE AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558
Practice Address - Country:US
Practice Address - Phone:708-246-3635
Practice Address - Fax:708-246-3637
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice