Basic Information
| Provider Information | |||||||||
| NPI: | 1255760989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIGUEL | ||||||||
| FirstName: | ROLAND | ||||||||
| MiddleName: | OSCAR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | HQ, 618TH DCAS/DENTAC | ||||||||
| Address2: | KOREA UNIT 15652 | ||||||||
| City: | APO | ||||||||
| State: | AP | ||||||||
| PostalCode: | 96271 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | HQ, 618TH DCAS/DENTAC | ||||||||
| Address2: | KOREA UNIT 15652 | ||||||||
| City: | APO | ||||||||
| State: | AP | ||||||||
| PostalCode: | 96271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157372600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2013 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 28960 | TX | N | Dental Providers | Dentist | 1223E0200X | 28960 | TX | Y | Dental Providers | Dentist | Endodontics |
No ID Information.