Provider Demographics
NPI:1780656835
Name:MILLER, ROGER LUCAS (PROSTHODONTIST)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:LUCAS
Last Name:MILLER
Suffix:
Gender:M
Credentials:PROSTHODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 NEALY BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23665-2022
Mailing Address - Country:US
Mailing Address - Phone:572-258-2767
Mailing Address - Fax:
Practice Address - Street 1:76 NEALY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23665-2022
Practice Address - Country:US
Practice Address - Phone:757-225-8276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51554169921122300000X
UT5155416-99211223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist