Provider Demographics
NPI:1003045444
Name:PATEL-MILLER, RITA G (DDS)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:G
Last Name:PATEL-MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307
Mailing Address - Country:US
Mailing Address - Phone:219-750-1150
Mailing Address - Fax:219-476-3990
Practice Address - Street 1:102 E 107TH AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307
Practice Address - Country:US
Practice Address - Phone:219-750-1150
Practice Address - Fax:219-476-3990
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027875122300000X
IN12011905A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist