Provider Demographics
NPI:1437231958
Name:MILLER, NICOLE I (DDS)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:I
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 1:12505 WESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-9225
Mailing Address - Country:US
Mailing Address - Phone:616-364-9348
Mailing Address - Fax:616-364-5950
Practice Address - Street 1:2515 ALPINE AVE NW
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1924
Practice Address - Country:US
Practice Address - Phone:616-364-9348
Practice Address - Fax:616-364-5950
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI189891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice