Provider Demographics
NPI:1184617037
Name:MILLER, MICHAEL WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:MILLER
Suffix:
Gender:M
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:PO BOX 158
Mailing Address - Street 2:428 MAIN ST
Mailing Address - City:ROSSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66533-9799
Mailing Address - Country:US
Mailing Address - Phone:785-584-6101
Mailing Address - Fax:785-584-5915
Practice Address - Street 1:426 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66533-9000
Practice Address - Country:US
Practice Address - Phone:785-584-6101
Practice Address - Fax:785-584-5915
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS52451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice