MEDICARE: DR. JEFFERY HAROLD MILLER 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	122300000X	Dentist	7889	MN

General Provider Information

NPI Number	:	1447367644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY HAROLD MILLER DDS

Provider Business Mailing Address
First Line	:	3345 DAKOTA AVE SO
Second Line	:
City	:	ST. LOUIS PARK
State	:	MN
Zip	:	55416
Country	:	US
Telephone Number	:	952-929-9450
Fax Number	:	952-929-1095

Provider Business Practice Location Address
First Line	:	3345 DAKOTA AVE SO
Second Line	:
City	:	ST. LOUIS PARK
State	:	MN
Zip	:	55416
Country	:	US
Telephone Number	:	952-929-9450
Fax Number	:	952-929-1095

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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