Provider Demographics
NPI:1659402022
Name:RJ MIRIANI DDS PC
Entity Type:Organization
Organization Name:RJ MIRIANI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARTER
Authorized Official - Middle Name:W
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-685-2636
Mailing Address - Street 1:BOX 160
Mailing Address - Street 2:126 E MAIN ST
Mailing Address - City:ROSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48654-0160
Mailing Address - Country:US
Mailing Address - Phone:989-685-2636
Mailing Address - Fax:989-685-8477
Practice Address - Street 1:126 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSE CITY
Practice Address - State:MI
Practice Address - Zip Code:48654-0160
Practice Address - Country:US
Practice Address - Phone:989-685-2636
Practice Address - Fax:989-685-8477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI012868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty