MEDICARE: DR. THOMAS JAMES MILLER DDS

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	0520531	NY

General Provider Information

NPI Number	:	1386640621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JAMES MILLER DDS

Provider Business Mailing Address
First Line	:	3 KINGSLEY CIR
Second Line	:	APT 4
City	:	FAIRPORT
State	:	NY
Zip	:	14450-2664
Country	:	US
Telephone Number	:	716-909-1480
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 MASON ST
Second Line	:
City	:	NEWARK
State	:	NY
Zip	:	14513-1459
Country	:	US
Telephone Number	:	315-331-4115
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	03/21/2014

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