Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0401410399 | VA |
NPI | 1003917634 |
---|---|
Provider Name | Richards Rudd Miller |
First Address | Waynesboro, VA 22980 |
Second Address | Waynesboro, VA 22980 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1354201 | UNITED CONCORDIA (01) | |
201256 | ANTHEM BCBS (01) |