Provider Demographics
NPI:1790994325
Name:MILLER, RALPH (DDS)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:
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 1:2937 SISKIYOU BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8100
Mailing Address - Country:US
Mailing Address - Phone:541-773-8216
Mailing Address - Fax:541-773-6898
Practice Address - Street 1:2937 SISKIYOU BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8100
Practice Address - Country:US
Practice Address - Phone:541-773-8216
Practice Address - Fax:541-773-6898
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD87101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice