Provider Demographics
NPI:1952405474
Name:ROBERT B. MILLER, IV, DDS, PLLC
Entity Type:Organization
Organization Name:ROBERT B. MILLER, IV, DDS, PLLC
Other - Org Name:COMPLETE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-626-9729
Mailing Address - Street 1:1505 S GLENBURNIE RD STE J
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2632
Mailing Address - Country:US
Mailing Address - Phone:252-672-4404
Mailing Address - Fax:252-672-4402
Practice Address - Street 1:1505 S GLENBURNIE RD STE J
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2632
Practice Address - Country:US
Practice Address - Phone:252-672-4404
Practice Address - Fax:252-672-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902574Medicaid
NC5950777Medicaid
NC89015C2Medicaid