MEDICARE: JACQUELINE A MILLER R.D.H.

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	H 4795	AZ

General Provider Information

NPI Number	:	1376757229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE A MILLER R.D.H.

Provider Business Mailing Address
First Line	:	5810 E LUDLOW DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-3133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7150 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-5300
Country	:	US
Telephone Number	:	602-230-0811
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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