MEDICARE: DR. TREVOR DWAYNE MILLER D.M.D.

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	D8418	OR

General Provider Information

NPI Number	:	1407840226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREVOR DWAYNE MILLER D.M.D.

Provider Business Mailing Address
First Line	:	2107 57TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-1713
Country	:	US
Telephone Number	:	916-425-6230
Fax Number	:

Provider Business Practice Location Address
First Line	:	2107 57TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-1713
Country	:	US
Telephone Number	:	916-425-6230
Fax Number	:

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	04/30/2009

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