Provider Demographics
NPI:1184605578
Name:MILLER, CRAIG ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ROBERT
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 E MAIN ST
Mailing Address - Street 2:STE 106
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2529
Mailing Address - Country:US
Mailing Address - Phone:631-727-0103
Mailing Address - Fax:631-727-5423
Practice Address - Street 1:518 E MAIN ST
Practice Address - Street 2:STE 106
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2529
Practice Address - Country:US
Practice Address - Phone:631-727-0103
Practice Address - Fax:631-727-5423
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0288581122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00389120Medicaid