MEDICARE: NICOLE 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	122300000X	Dentist	27002	TX

General Provider Information

NPI Number	:	1457625626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MILLER D.D.S.

Provider Business Mailing Address
First Line	:	4050 I-20 W
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 I-20 W
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1435
Country	:	US
Telephone Number	:	817-563-1111
Fax Number	:

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

Provider Enumeration Date	:	03/05/2012
Last Update Date	:	03/05/2012

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Directions to “ NICOLE MILLER D.D.S.” Practice Location

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