| Doctor Name: | DR. MARK D. MILLER |
| NPI Number: | 1104982016 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DDS PSC |
| License Number: | 6861 |
| Business Practice Address: | 320 Cool Water Ct Hopkinsville, KY - 422408738 |
| Business Phone Number: | 2708850165 |
| Business Fax Number: | 2708862224 |
| Mailing Address: | 320 Cool Water Ct, HOPKINSVILLE |
| State: | KY |
| Postal Code: | 422408738 |
| Phone Number: | 2708850165 |
| Fax Number: | 2708862224 |
| NPI Enumeration Date: | 12/28/2006 |
| NPI Last Update Date: | 06/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204E00000X |
| License Number: | 6861 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Oral & Maxillofacial Surgery |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |