Provider Demographics
NPI:1861123341
Name:NICOLLE MILLER, DDS A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:NICOLLE MILLER, DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-585-9598
Mailing Address - Street 1:197 WOODLAND PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-3020
Mailing Address - Country:US
Mailing Address - Phone:760-585-9598
Mailing Address - Fax:
Practice Address - Street 1:197 WOODLAND PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3020
Practice Address - Country:US
Practice Address - Phone:760-585-9598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental