Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019027875 | IL |
Y | 122300000X | Dentist | 12011905A | IN |
NPI | 1003045444 |
---|---|
Provider Name | Rita G. Patel-Miller |
First Address | Crown Point, IN 46307 |
Second Address | Crown Point, IN 46307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 24/01/2014 |