Healthcare Provider Details

I. General information

NPI: 1144926221
Provider Name (Legal Business Name): RICHARD T MILLER DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 NORTHERN BLVD STE 100
GREAT NECK NY
11021-5208
US

IV. Provider business mailing address

500 CHAPMAN ST
CANTON MA
02021-2093
US

V. Phone/Fax

Practice location:
  • Phone: 781-562-0457
  • Fax: 339-237-3307
Mailing address:
  • Phone: 781-562-0467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: LORRAINE MATHEUS
Title or Position: CREDENTIALING
Credential:
Phone: 781-562-0457