MEDICARE: DR. KAREN ELAINE MILLER D.D.S.

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	1223G0001X	General Practice Dentistry	DS028062L	PA

General Provider Information

NPI Number	:	1255578472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN ELAINE MILLER D.D.S.

Provider Business Mailing Address
First Line	:	3401 MARKET STREET
Second Line	:	SUITE 110 PENN DENTAL AT UNIVERSITY CITY
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6228
Country	:	US
Telephone Number	:	215-573-8400
Fax Number	:	215-573-5550

Provider Business Practice Location Address
First Line	:	3401 MARKET STREET
Second Line	:	SUITE 110 PENN DENTAL AT UNIVERSITY CITY
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6228
Country	:	US
Telephone Number	:	215-573-8400
Fax Number	:	215-573-5550

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

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	01/09/2009

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