MEDICARE: WILLIE L MILLER D.D.S., P.A.

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	2341	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	591842	OTHER	SC	TRICARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710939913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIE L MILLER D.D.S., P.A.

Provider Business Mailing Address
First Line	:	9110 GARNERS FERRY RD
Second Line	:
City	:	HOPKINS
State	:	SC
Zip	:	29061-9561
Country	:	US
Telephone Number	:	803-783-2686
Fax Number	:	803-783-7519

Provider Business Practice Location Address
First Line	:	9110 GARNERS FERRY RD
Second Line	:
City	:	HOPKINS
State	:	SC
Zip	:	29061-9561
Country	:	US
Telephone Number	:	803-783-2686
Fax Number	:	803-783-7519

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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