Provider Demographics
NPI:1417052192
Name:MILLER PLACES DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:MILLER PLACES DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICHLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-744-0202
Mailing Address - Street 1:P.O. BOX 5600
Mailing Address - Street 2:555 ROUTE 25 A
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764
Mailing Address - Country:US
Mailing Address - Phone:631-744-0202
Mailing Address - Fax:631-744-0257
Practice Address - Street 1:555 ROUTE 25 A
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764
Practice Address - Country:US
Practice Address - Phone:631-744-0202
Practice Address - Fax:631-744-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0295661223G0001X
NY0294861223G0001X
NY0351861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty