Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 15066 | TX |
NPI | 1013001239 |
---|---|
Provider Name | Dr. David Lawrence Miller |
First Address | Rockwall, TX 75087-8747 |
Second Address | Rockwall, TX 75087-8747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 05/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U08447 | (02) | TX |