Individual
KENNETH GORDON MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
233 NORTHERN BLVD, STE 5, CLARKS SUMMIT, PA 18411-8720
(570) 586-5300
(570) 586-4720
Mailing address
233 NORTHERN BLVD, STE 5, CLARKS SUMMIT, PA 18411-8720
(570) 954-8211
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
021625L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00905525
—
PA
Enumeration date
11/02/2006
Last updated
02/28/2017
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