MEDICARE: JEFFREY H. MILLER, 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	1223G0001X	General Practice Dentistry	7889	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1447367644	OTHER	MN	NPI TYPE 1

General Provider Information

NPI Number	:	1174797476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY H. MILLER, DDS.

Provider Business Mailing Address
First Line	:	3345 DAKOTA AVE S
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-2039
Country	:	US
Telephone Number	:	952-929-9450
Fax Number	:	952-929-1095

Provider Business Practice Location Address
First Line	:	3345 DAKOTA AVE S
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-2039
Country	:	US
Telephone Number	:	952-929-9450
Fax Number	:	952-929-1095

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. KAREN HATLING
Credential	:
Telephone Number	:	952-929-9450

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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