Provider Demographics
NPI:1255411245
Name:MILLER, KEVIN BLAINE (DMD MS DOCTOR OF DEN)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BLAINE
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD MS DOCTOR OF DEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1564 CONSTITUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3004
Mailing Address - Country:US
Mailing Address - Phone:803-327-1144
Mailing Address - Fax:803-328-2100
Practice Address - Street 1:1564 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3004
Practice Address - Country:US
Practice Address - Phone:803-327-1144
Practice Address - Fax:803-328-2100
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4079OtherLIC