Provider Demographics
NPI:1629085311
Name:MILLER, RICHARD ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
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 1:11801 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2734
Mailing Address - Country:US
Mailing Address - Phone:301-468-9383
Mailing Address - Fax:301-468-3010
Practice Address - Street 1:11801 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 107
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2734
Practice Address - Country:US
Practice Address - Phone:301-468-9383
Practice Address - Fax:301-468-3010
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD67061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice