Provider Demographics
NPI:1548279854
Name:MILLER, EUGENE REINHARDT JR
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:REINHARDT
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:R
Other - Last Name:MILLER
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:LD
Mailing Address - Street 1:415 N BRIDGETON RD SLIP 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-8080
Mailing Address - Country:US
Mailing Address - Phone:503-735-9876
Mailing Address - Fax:
Practice Address - Street 1:14406 NE 20TH AVE
Practice Address - Street 2:KAISER, SALMON CREEK DENTAL OFFICE
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-1448
Practice Address - Country:US
Practice Address - Phone:360-571-3139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000216122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist