Individual
DR. GLENN A MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDSMS
Contact information
Practice address
10200 WEST MAIN STREET, SIGNAL HILL MEDICAL BUILDING, BELLEVILLE, IL 62223-1495
(618) 397-2464
(618) 398-4450
Mailing address
10200 WEST MAIN STREET, SIGNAL HILL MEDICAL BUILDING, BELLEVILLE, IL 62223-1495
(618) 397-2464
(618) 398-4450
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
19A13884
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
679927
UNITED CONCORDIA
—
01
—
80115934
ILLINOIS BLUE SHIELD
IL
Enumeration date
10/16/2006
Last updated
07/08/2007
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