Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 12230 | MA |
NPI | 1023219060 |
---|---|
Provider Name | Dr. Brian H. Miller |
First Address | Waban, MA 02468-1415 |
Second Address | Concord, MA 01742-3313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0272019 | (05) | MA |