Provider Demographics
NPI:1598872061
Name:MILLER, RICHARD ROSCOE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ROSCOE
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 1:19 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-1251
Mailing Address - Country:US
Mailing Address - Phone:706-857-4741
Mailing Address - Fax:706-857-2713
Practice Address - Street 1:19 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-1251
Practice Address - Country:US
Practice Address - Phone:706-857-4741
Practice Address - Fax:706-857-2713
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0086191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000216136ACMedicaid