MEDICARE: DENTAL IMPLANTS AND SPECIALTY SERVICES

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

General Provider Information

NPI Number	:	1124787643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL IMPLANTS AND SPECIALTY SERVICES

Provider Business Mailing Address
First Line	:	5202 SUTLIVE ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-4514
Country	:	US
Telephone Number	:	912-525-7777
Fax Number	:	912-525-7779

Provider Business Practice Location Address
First Line	:	5202 SUTLIVE ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-4514
Country	:	US
Telephone Number	:	912-525-7777
Fax Number	:	912-525-7779

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT B MILLER
Credential	:	DMD
Telephone Number	:	912-525-7777

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	12/13/2021

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