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NPI Code Detail

MEDICARE: MS. TRACIE R MILLER RDH

MEDICARE: MS. TRACIE R MILLER RDH
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
1124Q00000XDental Hygienist2716-94DHMS

General Provider Information

NPI Number : 1548409485
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TRACIE R MILLER RDH
Provider Business Mailing Address
First Line : 2574 MARCIA CT
Second Line :
City : BILOXI
State : MS
Zip : 39531-2341
Country : US
Telephone Number : 228-388-9545
Fax Number : 228-385-1161
Provider Business Practice Location Address
First Line : 2574 MARCIA CT
Second Line :
City : BILOXI
State : MS
Zip : 39531-2341
Country : US
Telephone Number : 228-388-9545
Fax Number : 228-385-1161
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2009
Last Update Date : 02/17/2009

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