Miller, Mark D.

Miller, Mark D. is an individual health care provider with primary practice located at 1211 W Broadway Unit 106 , Louisville KY 40203-2082. He recently has 3 registered licenses in different health care specialties including Dental Providers / Dentist Anesthesiologist, Dental Providers / Oral and Maxillofacial Surgery, Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery. Dental Providers / Oral and Maxillofacial Surgery is his primary health care specialty. Miller, Mark D. can be contacted via phone (270) 885-0165.

Contact Information

Primary practice address
1211 W Broadway Unit 106 Louisville KY 40203-2082
Phone: (270) 885-0165
Fax: (270) 886-2224
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist Anesthesiologist 1223D0004X 6861 Kentucky
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 36087 Texas
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X 6861 Kentucky
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 6861 Kentucky

Profile Details

NPI number 1104982016
LBN Legal business name Miller, Mark D.
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 28th, 2006
Last updated Jun 24th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104982016 NPPES
Kentucky MEDICAID 60068616
Kentucky MEDICAID 64068612

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