Provider Demographics
NPI:1154480119
Name:MILLER, RICHARD L JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:MILLER
Suffix:JR
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 1:760 ASH AVE
Mailing Address - Street 2:PO BOX 0307
Mailing Address - City:BIRD ISLAND
Mailing Address - State:MN
Mailing Address - Zip Code:55310-0307
Mailing Address - Country:US
Mailing Address - Phone:320-365-3130
Mailing Address - Fax:320-365-3131
Practice Address - Street 1:760 ASH AVE
Practice Address - Street 2:
Practice Address - City:BIRD ISLAND
Practice Address - State:MN
Practice Address - Zip Code:55310-0307
Practice Address - Country:US
Practice Address - Phone:320-365-3130
Practice Address - Fax:320-365-3131
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN85131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice