Provider Demographics
NPI:1114045259
Name:ROBERT A. MILLER, DDS, MS, P.C.
Entity Type:Organization
Organization Name:ROBERT A. MILLER, DDS, MS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:313-561-0400
Mailing Address - Street 1:2142 MONROE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3057
Mailing Address - Country:US
Mailing Address - Phone:313-561-0400
Mailing Address - Fax:313-561-8326
Practice Address - Street 1:2142 MONROE ST
Practice Address - Street 2:SUITE B
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3057
Practice Address - Country:US
Practice Address - Phone:313-561-0400
Practice Address - Fax:313-561-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0114691223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOTH000Medicare UPIN
MIOMO8120Medicare ID - Type Unspecified