Provider Demographics
NPI:1255105409
Name:MILLER, DANIEL ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBERT
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 BENNETT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-2129
Mailing Address - Country:US
Mailing Address - Phone:630-945-6104
Mailing Address - Fax:
Practice Address - Street 1:2633 CHATHAM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4185
Practice Address - Country:US
Practice Address - Phone:217-971-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0346271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice