Provider Demographics
NPI:1033365788
Name:ANKERMILLER, MICHAEL D (LICENSED DENTURIST)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:ANKERMILLER
Suffix:
Gender:M
Credentials:LICENSED DENTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:BENTON CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99320-1400
Mailing Address - Country:US
Mailing Address - Phone:509-308-1073
Mailing Address - Fax:
Practice Address - Street 1:1225 MEADE AVE
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-1423
Practice Address - Country:US
Practice Address - Phone:509-308-1073
Practice Address - Fax:509-308-1073
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN 00000473122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5056965OtherDEPARTMENT OF SOCIAL AND HEALTH SERVICES