Provider Demographics
NPI:1902970734
Name:MILLER, ROGER DUANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DUANE
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 1:811 WEST GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48875
Mailing Address - Country:US
Mailing Address - Phone:517-647-7878
Mailing Address - Fax:517-647-2916
Practice Address - Street 1:811 WEST GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:MI
Practice Address - Zip Code:48875
Practice Address - Country:US
Practice Address - Phone:517-647-7878
Practice Address - Fax:517-647-2916
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist