Healthcare Provider Details

I. General information

NPI: 1679513972
Provider Name (Legal Business Name): RAYMOND GERARD MILLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 COMO PARK BLVD
LANCASTER NY
14086-3068
US

IV. Provider business mailing address

122 COVINGTON RD
BUFFALO NY
14216-2104
US

V. Phone/Fax

Practice location:
  • Phone: 716-683-7666
  • Fax: 716-685-9265
Mailing address:
  • Phone: 716-834-3112
  • Fax: 716-685-9265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39456
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: