Provider Demographics
NPI:1538369368
Name:MILLER, MICHAEL BURNS JR (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BURNS
Last Name:MILLER
Suffix:JR
Gender:M
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:PO BOX 748
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-0748
Mailing Address - Country:US
Mailing Address - Phone:208-476-4315
Mailing Address - Fax:
Practice Address - Street 1:1265 AHSAHKA RD
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9025
Practice Address - Country:US
Practice Address - Phone:208-476-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD34741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice