MEDICARE: DR. THOMAS CLEMENT 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	1223G0001X	General Practice Dentistry	10728	TX

General Provider Information

NPI Number	:	1386656965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS CLEMENT MILLER JR. DDS

Provider Business Mailing Address
First Line	:	2300 WOODFOREST PARKWAY N SUITE 700
Second Line	:
City	:	MONTGOMERY
State	:	TX
Zip	:	77316
Country	:	US
Telephone Number	:	936-249-6300
Fax Number	:	936-249-6300

Provider Business Practice Location Address
First Line	:	2300 WOODFOREST PARKWAY N SUITE 700
Second Line	:
City	:	MONTGOMERY
State	:	TX
Zip	:	77316
Country	:	US
Telephone Number	:	936-249-6300
Fax Number	:	936-249-6300

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	01/17/2019

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