MEDICARE: PATRICK MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	DH071201	PA
2	124Q00000X	Dental Hygienist	DH10473	MA

General Provider Information

NPI Number	:	1184984684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK MILLER

Provider Business Mailing Address
First Line	:	646 SWIFT RD
Second Line	:
City	:	WEST POINT
State	:	NY
Zip	:	10996-1942
Country	:	US
Telephone Number	:	845-938-3121
Fax Number	:	845-938-4302

Provider Business Practice Location Address
First Line	:	646 SWIFT RD
Second Line	:
City	:	WEST POINT
State	:	NY
Zip	:	10996-1942
Country	:	US
Telephone Number	:	845-938-3121
Fax Number	:	845-938-4302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2012
Last Update Date	:	05/18/2012

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Directions to “ PATRICK MILLER ” Practice Location

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