Provider Demographics
NPI:1164701397
Name:MIYA, ROGER CRAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CRAIG
Last Name:MIYA
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 1:16315 E WHITTIER BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603
Mailing Address - Country:US
Mailing Address - Phone:562-943-1055
Mailing Address - Fax:562-943-1655
Practice Address - Street 1:16315 WHITTIER BLVD STE 205
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2910
Practice Address - Country:US
Practice Address - Phone:562-943-1055
Practice Address - Fax:562-943-1655
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist