Basic Information
| Provider Information | |||||||||
| NPI: | 1316380835 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | LISA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 EARLES CT | ||||||||
| Address2: | |||||||||
| City: | NARRAGANSETT | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028823929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077444034 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4066 602ND STREET | ||||||||
| Address2: | |||||||||
| City: | FORT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073615530 | ||||||||
| FaxNumber: | 9073614859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2013 | ||||||||
| LastUpdateDate: | 04/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DEN.00203471 | CO | Y | Dental Providers | Dentist | 122300000X | 8708209-9922 | UT | N | Dental Providers | Dentist |
No ID Information.