MEDICARE: MAURICE SEBASTIAN MILES 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	13453	MD

General Provider Information

NPI Number	:	1679621296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURICE SEBASTIAN MILES D.D.S

Provider Business Mailing Address
First Line	:	13916 BALTIMORE AVE
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-5009
Country	:	US
Telephone Number	:	301-498-6511
Fax Number	:	301-776-0054

Provider Business Practice Location Address
First Line	:	13916 BALTIMORE AVE
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-5009
Country	:	US
Telephone Number	:	301-498-6511
Fax Number	:	301-776-0054

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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