Individual
MARIA MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.H.
Contact information
Practice address
111 N. JEFFERSON ST, SUITE 1, MARSHALL, MI 49068
(269) 781-0952
Mailing address
111 N. JEFFERSON ST, SUITE 1, MARSHALL, MI 49068
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2902011392
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38-3387719
THE FOUNTAIN CLINIC
MI
Enumeration date
02/08/2016
Last updated
02/08/2016
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