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Individual

DR. COLETTA M MILLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.D.S.

Contact information

Practice address
3740 E LAKE CTR, QUINCY, IL 62305-5805
(217) 224-6789
(217) 224-9675
Mailing address
3740 E LAKE CTR, QUINCY, IL 62305-5805
(217) 224-6789
(217) 224-9675

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
021-001383
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0589937
IA
05
102687
IL
Enumeration date
06/27/2005
Last updated
08/27/2010
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