Individual
JACK RANDOLPH MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2078 NE PROFESSIONAL CT, BEND, OR 97701-6077
(541) 382-2281
Mailing address
2078 NE PROFESSIONAL CT, BEND, OR 97701-6077
(541) 382-2281
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7074
OR
Other
Enumeration date
05/20/2008
Last updated
09/02/2008
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