Provider Demographics
NPI:1215926027
Name:MILLER, ROBERT A (DDS MS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2922
Mailing Address - Country:US
Mailing Address - Phone:313-561-0400
Mailing Address - Fax:313-561-8326
Practice Address - Street 1:2135 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2922
Practice Address - Country:US
Practice Address - Phone:313-561-0400
Practice Address - Fax:313-561-8326
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0114691223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
507814OtherMIDA
970H27859OtherBLUE CROSS
U06347Medicare UPIN
970H27859OtherBLUE CROSS