Provider Demographics
NPI:1487227351
Name:MILLER, DALE RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:RICHARD
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PAINTED BUNTING DR
Mailing Address - Street 2:
Mailing Address - City:TROUTMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28166-9505
Mailing Address - Country:US
Mailing Address - Phone:704-315-8400
Mailing Address - Fax:
Practice Address - Street 1:528 WILLIAMSON RD STE 201
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8199
Practice Address - Country:US
Practice Address - Phone:704-660-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC124061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice