Provider Demographics
NPI:1013183797
Name:MILLER, RANDALL WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:WAYNE
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SADDLEBROOK TER
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2453
Mailing Address - Country:US
Mailing Address - Phone:770-518-5682
Mailing Address - Fax:
Practice Address - Street 1:275 SADDLEBROOK TER
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2453
Practice Address - Country:US
Practice Address - Phone:770-518-5682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0106171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice