Miller, Mark D.
Miller, Mark D. is an individual health care provider with primary practice located at 1211 W Broadway Unit 106 , Louisville KY 40203-2082. He recently has 3 registered licenses in different health care specialties including Dental Providers / Dentist Anesthesiologist, Dental Providers / Oral and Maxillofacial Surgery, Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery. Dental Providers / Oral and Maxillofacial Surgery is his primary health care specialty. Miller, Mark D. can be contacted via phone (270) 885-0165.Contact Information
Primary practice address
1211 W Broadway Unit 106
Louisville KY 40203-2082
Phone: (270) 885-0165
Fax: (270) 886-2224
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist Anesthesiologist | 1223D0004X | 6861 | Kentucky |
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 36087 | Texas |
| Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery | 204E00000X | 6861 | Kentucky |
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 6861 | Kentucky |
Profile Details
| NPI number | 1104982016 |
|---|---|
| LBN Legal business name | Miller, Mark D. |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 28th, 2006 |
| Last updated | Jun 24th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104982016 | NPPES |
| Kentucky | MEDICAID | 60068616 | |
| Kentucky | MEDICAID | 64068612 |
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