Provider Demographics
NPI:1043606718
Name:RICHARD P MILLER DMD PC
Entity Type:Organization
Organization Name:RICHARD P MILLER DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-476-4667
Mailing Address - Street 1:1100 NE 7TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1415
Mailing Address - Country:US
Mailing Address - Phone:541-476-4667
Mailing Address - Fax:541-476-3669
Practice Address - Street 1:1100 NE 7TH ST
Practice Address - Street 2:STE B
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1415
Practice Address - Country:US
Practice Address - Phone:541-476-4667
Practice Address - Fax:541-476-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6459261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental