Individual
DR. JOHN RANDALL MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5800 GODFREY RD, GODFREY, IL 62035-2426
(618) 468-4414
(618) 468-2394
Mailing address
5800 GODFREY RD, GODFREY, IL 62035-2426
(618) 468-4414
(618) 468-2394
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9176253
—
IL
Enumeration date
02/25/2008
Last updated
02/25/2008
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