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NPISignal

Individual Healthcare Provider

Mark D. Miller, DDS

NPI Record: ActiveDentist — Oral and Maxillofacial Surgery
NPI1104982016
Louisville, Kentucky

Provider's NPPES record last updated: June 24, 2020

Overview

Entity Type
Individual Healthcare Provider
NPI
1104982016
Primary Specialty
Dentist — Oral and Maxillofacial Surgery
Practice Location
Louisville, Kentucky
Sole Proprietor
No

Federal Screening

NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.

List of Excluded Individuals/Entities (LEIE)

HHS Office of Inspector General

No potential match identified

No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.

Source data
September 10, 2026
Records indexed
84,001
Screened
Sep 18, 2026, 11:10 AM UTC

This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.

SAM.gov Exclusions

U.S. General Services Administration

Not checked

SAM.gov Exclusions was not checked.

SAM.gov screening is not configured on this deployment. No SAM check has been performed.

Screened
Not checked

This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.

This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.

Run a name-based screening

Searches OIG LEIE and SAM.gov by name and reviews every potential match.

Specialties & Taxonomies

  • Dentist

    Oral and Maxillofacial Surgery

    Dental Providers

    Primary

    The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

    Taxonomy code 1223S0112X
  • Dentist

    Dental Anesthesiology

    Dental Providers

    A dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years duration, in accord with Commission on Dental Accreditation's Standards for Dental Anesthesiology Residency Programs, and/or meets the eligibility requirements for examination by the American Dental Board of Anesthesiology.

    Taxonomy code 1223D0004X
  • Oral & Maxillofacial Surgery

    Allopathic & Osteopathic Physicians

    Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery.

    Taxonomy code 204E00000X

Provider-Reported License Information

Dentist (Kentucky)
6861
Dentist (Kentucky)
6861
Dentist (Texas)
36087
Oral & Maxillofacial Surgery (Kentucky)
6861
License numbers are reported by the provider to NPPES and are not independently verified by NPISignal against any state licensing board. Confirm current license status directly with the issuing state board.

Practice Locations

Practice Location

1211 W Broadway Unit 106

Louisville, Kentucky 40203-2082

Phone: (270) 885-0165

Additional Practice Location

2400 Richmond Rd Ste 133

Texarkana, Texas 75503-2464

Phone: (903) 306-0790

Fax: (903) 831-9940

Record Information

Enumeration Date
December 28, 2006
Provider's NPPES Record Last Updated
June 24, 2020
Certification Date
June 24, 2020
NPISignal NPPES Dataset
August 2026

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