MEDICARE: DR. SUSAN S. MILLER DDS, PLLC

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	DE00006218	WA

General Provider Information

NPI Number	:	1326188285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN S. MILLER DDS, PLLC

Provider Business Mailing Address
First Line	:	7750 15TH AVE NE
Second Line	:	SUITE A
City	:	SEATTLE
State	:	WA
Zip	:	98115-4314
Country	:	US
Telephone Number	:	206-402-3402
Fax Number	:	206-402-3460

Provider Business Practice Location Address
First Line	:	7750 15TH AVE NE
Second Line	:	SUITE A
City	:	SEATTLE
State	:	WA
Zip	:	98115-4314
Country	:	US
Telephone Number	:	206-402-3402
Fax Number	:	206-402-3460

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	01/14/2011

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