MEDICARE: RICK W 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	1223G0001X	General Practice Dentistry	14878	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14878	OTHER	TX	GENERAL DENTISTRY

General Provider Information

NPI Number	:	1487713939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICK W MILLER D.D.S

Provider Business Mailing Address
First Line	:	4536 BILTMOORE DR
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-6861
Country	:	US
Telephone Number	:	972-624-6249
Fax Number	:

Provider Business Practice Location Address
First Line	:	4222 TRINITY MILLS RD STE 118
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-7658
Country	:	US
Telephone Number	:	972-380-2118
Fax Number	:	972-380-1936

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/08/2007

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