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Individual

DR. CHARLES NOLAN MILLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
7631 W 145, APPLE VALLEY, MN 55124-5511
(952) 432-8696
(952) 432-8972
Mailing address
7631 W 145, APPLE VALLEY, MN 55124-5511
(952) 432-8696
(952) 432-8972

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10738
MN
1223G0001X
General Practice Dentistry
M826
SD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
09092 KU
BLUE CROSS BLUE SHIELD
MN
Enumeration date
07/31/2006
Last updated
07/08/2007
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