MEDICARE: DR. MARCUS STANLEY 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	122300000X	Dentist	12007495A	IN

General Provider Information

NPI Number	:	1184732588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCUS STANLEY MILLER DDS

Provider Business Mailing Address
First Line	:	894 SIM HODGIN PARKWAY
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1931
Country	:	US
Telephone Number	:	765-962-3713
Fax Number	:	765-966-0238

Provider Business Practice Location Address
First Line	:	894 SIM HODGIN PARKWAY
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1931
Country	:	US
Telephone Number	:	765-962-3713
Fax Number	:	765-966-0238

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2006
Last Update Date	:	07/08/2007

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