Provider Demographics
NPI:1144926221
Name:RICHARD T MILLER DMD PC
Entity type:Organization
Organization Name:RICHARD T MILLER DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-562-0457
Mailing Address - Street 1:500 CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2093
Mailing Address - Country:US
Mailing Address - Phone:781-562-0467
Mailing Address - Fax:
Practice Address - Street 1:611 NORTHERN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5208
Practice Address - Country:US
Practice Address - Phone:781-562-0457
Practice Address - Fax:339-237-3307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD T MILLER DMD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-01
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty