MEDICARE: DR. CLAYTON JAMES MILLER D.D.S

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	171000000X	Military Health Care Provider
2	1223G0001X	General Practice Dentistry	DN 21067	FL

General Provider Information

NPI Number	:	1407173883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAYTON JAMES MILLER D.D.S

Provider Business Mailing Address
First Line	:	201 MAITLAND AVE
Second Line	:	SUITE 1013
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4903
Country	:	US
Telephone Number	:	407-834-0330
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 MAITLAND AVE
Second Line	:	SUITE 1013
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4903
Country	:	US
Telephone Number	:	407-834-0330
Fax Number	:

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

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	04/21/2015

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