MEDICARE: ERNEST P MILLER JR DDS

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	261QD0000X	Dental Clinic/Center	23439	TX

General Provider Information

NPI Number	:	1053827881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERNEST P MILLER JR DDS

Provider Business Mailing Address
First Line	:	5138 UTSA BLVD STE 116
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3537
Country	:	US
Telephone Number	:	210-699-9761
Fax Number	:	210-699-0039

Provider Business Practice Location Address
First Line	:	5138 UTSA BLVD STE 116
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3537
Country	:	US
Telephone Number	:	210-699-9761
Fax Number	:	210-699-0039

Authorized Official
Title or Position	:	DENTIST
Name	:	ERNEST P MILLER JR.
Credential	:	DDS
Telephone Number	:	210-699-9761

Provider Enumeration Date	:	12/15/2017
Last Update Date	:	12/15/2017

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