MEDICARE: DR. ANDREW DAVID 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS037837	PA
2	122300000X	Dentist	DS037837	PA

General Provider Information

NPI Number	:	1417123654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW DAVID MILLER D.M.D

Provider Business Mailing Address
First Line	:	26 S BRYN MAWR AVE
Second Line	:
City	:	BRYN MAWR
State	:	PA
Zip	:	19010-3201
Country	:	US
Telephone Number	:	267-252-2154
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 WALNUT ST STE 215
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2902
Country	:	US
Telephone Number	:	215-557-7949
Fax Number	:	267-491-6886

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

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	03/26/2024

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