Active NPI
David Edward Miller Jr., DDS
- General Practice Dentistry
- Winston Salem, NC
National Provider Identifier
1255400016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4796
- Practice address
- 1410 Plaza West Rd
Winston Salem, NC 27103 - Phone
- (336) 765-1881
- Fax
- (336) 765-3250
- NPI assigned
- Nov 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4796 | NC | Primary |
Addresses
Primary practice location
1410 Plaza West Rd
Winston Salem, NC 27103
Mailing address
7529 Maidwood CT
Clemmons, NC 27012
Phone (336) 766-7341
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8995952 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4796 | NC | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255400016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7529 MAIDWOOD CT",
"city": "CLEMMONS",
"state": "NC",
"postal_code": "27012",
"telephone_number": "336-766-7341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1410 PLAZA WEST RD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "27103",
"telephone_number": "336-765-1881",
"fax_number": "336-765-3250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "DAVID",
"middle_name": "EDWARD",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "4796",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8995952",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.