Provider Demographics
NPI:1003913492
Name:MILLER, RONALD L (MSD, DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:MILLER
Suffix:
Gender:M
Credentials:MSD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W CARMEL DR
Mailing Address - Street 2:STE 201
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5802
Mailing Address - Country:US
Mailing Address - Phone:317-844-6284
Mailing Address - Fax:317-580-9495
Practice Address - Street 1:715 W CARMEL DR
Practice Address - Street 2:STE 201
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5802
Practice Address - Country:US
Practice Address - Phone:317-844-6284
Practice Address - Fax:317-580-9495
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120095791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics