Todd D Miller, D.M.D.

Key facts

NPI

1487749149

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

019024781 (IL)

Practice address

190 Marquette PL S
Manteno, IL 60950-3721

Phone

(815) 468-3020

Fax

(815) 468-3292

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 1

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.

• Premier Family Dental General Practice Dentistry · Manteno, IL · NPI 1932089513
  NPD (past) Authorized official GENERAL PRACTICE

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Opted out of Medicare

Yes, effective Apr 18, 2016 through Apr 18, 2028

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 8, 2017.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510099200000",
    "number": "1487749149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 MARQUETTE PL S",
            "city": "MANTENO",
            "state": "IL",
            "postal_code": "609503721",
            "telephone_number": "815-468-3020",
            "fax_number": "815-468-3292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 MARQUETTE PL S",
            "city": "MANTENO",
            "state": "IL",
            "postal_code": "609503721",
            "telephone_number": "815-468-3020",
            "fax_number": "815-468-3292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "TODD",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2017-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019024781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Manteno, IL · General Practice Dentistry in Illinois