Provider Demographics
NPI:1538050612
Name:MILLER, MIKAYLA ROSE (RDH)
Entity type:Individual
Prefix:MS
First Name:MIKAYLA
Middle Name:ROSE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALLADASBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17740-7409
Mailing Address - Country:US
Mailing Address - Phone:814-221-3592
Mailing Address - Fax:
Practice Address - Street 1:471 HEPBURN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6122
Practice Address - Country:US
Practice Address - Phone:570-567-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH075247124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist