Active NPI
Kenneth Bryce Miller, DDS
- Dentist
- Evergreen Park, IL
National Provider Identifier
1255589750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.015505
- Practice address
- 2809 W 95TH
Evergreen Park, IL 60805 - Phone
- (708) 425-3336
- NPI assigned
- Sep 9, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 019.015505 | IL | Primary |
Addresses
Primary practice location
2809 W 95TH
Evergreen Park, IL 60805
Mailing address
2809 W 95TH
Evergreen Park, IL 60805
Phone (708) 425-3336
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 |
|---|---|---|---|
| 019.015505 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220918400000",
"number": "1255589750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2809 W 95TH",
"city": "EVERGREEN PARK",
"state": "IL",
"postal_code": "60805",
"telephone_number": "708-425-3336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2809 W 95TH",
"city": "EVERGREEN PARK",
"state": "IL",
"postal_code": "60805",
"telephone_number": "708-425-3336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "KENNETH",
"middle_name": "BRYCE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-09",
"last_updated": "2008-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.015505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evergreen Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.