Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5902 | KS |
NPI | 1043263858 |
---|---|
Provider Name | Dr. Craig E. Miller |
First Address | Hays, KS 67601-2152 |
Second Address | Hays, KS 67601-2152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 02/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5902 | DENTAL LICENSE (01) | KS |
8535 | DENTAL LICENSE (01) | CO |
BM8219366 | DEA (01) | CO |