MEDICARE: EVAN G 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	1223G0001X	General Practice Dentistry	30.026119	OH

General Provider Information

NPI Number	:	1518586601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN G MILLER DDS

Provider Business Mailing Address
First Line	:	11904 SYCAMORE TRCE
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-4403
Country	:	US
Telephone Number	:	614-967-9199
Fax Number	:

Provider Business Practice Location Address
First Line	:	11904 SYCAMORE TRCE
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-4403
Country	:	US
Telephone Number	:	614-967-9199
Fax Number	:

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

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	08/14/2025

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