Provider Demographics
NPI:1710514864
Name:MILLER, ROBERT DANIEL
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3969 NORTHVIEW TER
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1554
Mailing Address - Country:US
Mailing Address - Phone:651-343-0959
Mailing Address - Fax:
Practice Address - Street 1:1090 SHINGLE CREEK XING
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2684
Practice Address - Country:US
Practice Address - Phone:651-583-7256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist