Individual
DR. KEVIN BLAINE MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD MS DOCTOR OF DEN
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
4079
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4079
LIC
SC
Enumeration date
10/16/2006
Last updated
11/23/2009
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