Provider Demographics
NPI:1205804721
Name:MILLER, JASON R (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 ADAMS ST SE STE 215
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3759
Mailing Address - Country:US
Mailing Address - Phone:256-265-4950
Mailing Address - Fax:256-265-4949
Practice Address - Street 1:910 ADAMS ST SE STE 215
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3759
Practice Address - Country:US
Practice Address - Phone:256-265-4950
Practice Address - Fax:256-265-4949
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL050541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009996805Medicaid
AL051528752OtherBLUE CROSS
AL51117227OtherBCBS
AL009996825Medicaid
AL051528751OtherBLUE CROSS
AL129563Medicaid
AL051528747OtherBLUE CROSS
AL102G700181OtherMEDICARE GROUP PTAN
AL129559Medicaid
AL051528754OtherBLUE CROSS
AL009996815Medicaid
AL009996835Medicaid
AL102I850178OtherMEDICARE PTAN
AL051528754OtherBLUE CROSS
AL051556073Medicare ID - Type Unspecified