Provider Demographics
NPI:1497865554
Name:MILLER, ROGER LEE (DDS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:LEE
Last Name:MILLER
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 1:831 HARRIS ST
Mailing Address - Street 2:#B
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503
Mailing Address - Country:US
Mailing Address - Phone:707-443-8425
Mailing Address - Fax:707-443-5862
Practice Address - Street 1:831 HARRIS ST
Practice Address - Street 2:#B
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503
Practice Address - Country:US
Practice Address - Phone:707-443-8425
Practice Address - Fax:707-443-5862
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice