Individual
DR. MARK M MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1516 18TH ST, LAKE CHARLES, LA 70601
(337) 478-9994
Mailing address
1516 18TH ST, LAKE CHARLES, LA 70601
(337) 478-9994
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3313
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1833134
—
LA
Enumeration date
07/28/2006
Last updated
07/08/2007
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