=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417363904
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTHONY REED MILLER DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2014
-----------------------------------------------------
Last Update Date | 11/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1776 BLANDING BLVD
-----------------------------------------------------
City | MIDDLEBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32068-3836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-203-2335
-----------------------------------------------------
Fax | 904-406-9739
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1776 BLANDING BLVD
-----------------------------------------------------
City | MIDDLEBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32068-3836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-203-2335
-----------------------------------------------------
Fax | 904-406-9739
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN20741
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------