Kenneth Gordon Miller, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

021625L Issued in PA

Practice address

233 Northern Blvd
Ste 5
Clarks Summit, PA 18411-8720

Phone

(570) 586-5300

Fax

(570) 586-4720

NPI assigned

Nov 2, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pinnacle Oral & Maxillofacial Surgery Associates Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Clarks Summit, PA
  • NPI 1851505689
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488240000000",
    "number": "1255419305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 NORTHERN BLVD",
            "address_2": "STE 5",
            "city": "CLARKS SUMMIT",
            "state": "PA",
            "postal_code": "184118720",
            "telephone_number": "570-954-8211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 NORTHERN BLVD",
            "address_2": "STE 5",
            "city": "CLARKS SUMMIT",
            "state": "PA",
            "postal_code": "184118720",
            "telephone_number": "570-586-5300",
            "fax_number": "570-586-4720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KENNETH",
        "middle_name": "GORDON",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2017-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "021625L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00905525",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Metropolitan Optical
• Thomas Meyer, M.D.
• Brooke Mikesell
• Breanna Miller
• Calandria Miller, DMD
• Kandy Mills, PT
• Jillian Denise Mishko
• Jennifer Jill Mishkula-Morgan, PHARM D
• Marsha E Modery, MD
• Ashley Anne Monetta, SPEECH THERAPIST

• Oral and Maxillofacial Surgery (Dentist) in Clarks Summit, PA
• Providers in Clarks Summit, PA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.