NPIMap

Organization Active NPI

Randall L Miller DDS LLC

  • Dentist
  • Shelbyville, IN
National Provider Identifier
1508284837
Registry record updated Apr 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12009483A Issued in IN
Legal business name
RANDALL L MILLER DDS LLC
Practice address
117 W Washington St
Shelbyville, IN 46176-1245
Phone
(317) 398-2103
Fax
(317) 421-1570
NPI assigned
Apr 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Randall Lee Miller, DDSNPI 1689721508
Title
Owner/Dentist
Phone
(317) 398-2103

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 12009483A IN Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 12010992A IN

Addresses

Primary practice location

117 W Washington St
Shelbyville, IN 46176-1245

Mailing address

117 W Washington St
Shelbyville, IN 46176-1245
Phone (317) 398-2103

Other identifiers 1

IdentifierTypeStateIssuer
100224820AMedicaidIN

National Provider Directory

National Provider Directory

Locations

117 W Washington St
Shelbyville, IN 46176
Phone (317) 398-2103

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396483200000",
    "number": "1508284837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 W WASHINGTON ST",
            "city": "SHELBYVILLE",
            "state": "IN",
            "postal_code": "461761245",
            "telephone_number": "317-398-2103",
            "fax_number": "317-421-1570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 W WASHINGTON ST",
            "city": "SHELBYVILLE",
            "state": "IN",
            "postal_code": "461761245",
            "telephone_number": "317-398-2103",
            "fax_number": "317-421-1570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDALL L MILLER DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-03",
        "last_updated": "2014-04-03",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "317-398-2103",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12009483A",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12010992A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100224820A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelbyville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.