MEDICARE: JOSEPH ANTHONY MILLER D.M.D.

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	2901600454	MI
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1223G0001X	General Practice Dentistry	12014170A	IN

General Provider Information

NPI Number	:	1659938108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH ANTHONY MILLER D.M.D.

Provider Business Mailing Address
First Line	:	9611 WHITE HEMLOCK LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-4416
Country	:	US
Telephone Number	:	440-829-6081
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 S HARDING ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46221-1873
Country	:	US
Telephone Number	:	317-775-1288
Fax Number	:

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

Provider Enumeration Date	:	05/21/2019
Last Update Date	:	08/08/2023

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