Provider Demographics
NPI:1255760989
Name:MIGUEL, ROLAND OSCAR III (DDS)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:OSCAR
Last Name:MIGUEL
Suffix:III
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:CMR 427 BOX 28
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09630-0001
Mailing Address - Country:US
Mailing Address - Phone:315-636-9680
Mailing Address - Fax:
Practice Address - Street 1:US ARMY HEALTH CLINIC VICENZA
Practice Address - Street 2:UNIT 31401
Practice Address - City:VICENZA
Practice Address - State:VI
Practice Address - Zip Code:36100
Practice Address - Country:IT
Practice Address - Phone:315-636-9680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28960122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist