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General NPI Number Information
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NPI Number | 1114006541
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Entity Type | Individual
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Provider Name | DR. JAN S MILLER
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Gender | Male
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Dates
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Enumeration Date | 11/05/2006
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Last Update Date | 10/17/2013
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Provider Practice Location Address
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Address Line | 635 BELLE TERRE RD SUITE 103
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1935
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Country | US
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Telephone | 631-743-9090
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Fax | 631-743-9091
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Provider Business Mailing Address
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Address Line | 635 BELLE TERRE RD SUITE 103
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1935
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Country | US
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Telephone | 631-743-9090
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Fax | 631-743-9091
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 038216
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License Number State | NY
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