Provider Demographics
NPI:1649448549
Name:ROGER K MILLER DDS PA
Entity type:Organization
Organization Name:ROGER K MILLER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:K
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:704-739-7956
Mailing Address - Street 1:P.O. BOX 638
Mailing Address - Street 2:
Mailing Address - City:KINGS MTN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-0638
Mailing Address - Country:US
Mailing Address - Phone:704-739-7956
Mailing Address - Fax:704-739-1659
Practice Address - Street 1:1303 PLAZA DR
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-2653
Practice Address - Country:US
Practice Address - Phone:704-739-7956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC50351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC95963OtherBC & BS
NC7995963Medicaid