Provider Demographics
NPI:1730694134
Name:MILLER, KRISTA LEIGH
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LEIGH
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8439 APACHE BND
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2313
Mailing Address - Country:US
Mailing Address - Phone:912-230-1709
Mailing Address - Fax:
Practice Address - Street 1:10003 NW MILITARY HWY STE 3209
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1892
Practice Address - Country:US
Practice Address - Phone:210-979-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6861124Q00000X
124Q00000X
TX17269124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist