Provider Demographics
NPI:1174797476
Name:JEFFREY H. MILLER, DDS.
Entity type:Organization
Organization Name:JEFFREY H. MILLER, DDS.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HATLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-929-9450
Mailing Address - Street 1:3345 DAKOTA AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2039
Mailing Address - Country:US
Mailing Address - Phone:952-929-9450
Mailing Address - Fax:952-929-1095
Practice Address - Street 1:3345 DAKOTA AVE S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2039
Practice Address - Country:US
Practice Address - Phone:952-929-9450
Practice Address - Fax:952-929-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN78891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1447367644OtherNPI TYPE 1