Richard Roscoe Miller Jr., DDS
Individual provider Active NPI General Practice Dentistry · Summerville, GA
NPI 1598872061 · NPPES record last updated Jun 6, 2016
Key facts
- NPI
- 1598872061
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 008619 (GA)
- Practice address
- 19 Walnut Ave
Summerville, GA 30747-1251 - Phone
- (706) 857-4741
- Fax
- (706) 857-2713
- NPI assigned
- Aug 23, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008619 | GA | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 008619 | GA | Yes |
Addresses
Primary practice location
19 Walnut Ave
Summerville, GA 30747-1251
Mailing address
19 Walnut Ave
Summerville, GA 30747-1251
Phone (706) 857-4741
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000216136AC | Medicaid | GA |
Other providers in Summerville, GA
- Lookout Mountain Community Services
- Lookout Mountain Community Services
- Lookout Mountain Community Services
- Wendy Martin
- Jacquelin Ann Miller
- Mindcare, LLC
- Stefanie Mitchell
- Amber Moore
- Murphy Chiropractic
- Kevin Dennis Murphy
All providers in Summerville, GA · General Practice Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.