MEDICARE: DR. MATTHEW KEITH 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	8738	NC

General Provider Information

NPI Number	:	1619260080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW KEITH MILLER DDS

Provider Business Mailing Address
First Line	:	8212 E OAK ISLAND DR
Second Line	:
City	:	OAK ISLAND
State	:	NC
Zip	:	28465-8057
Country	:	US
Telephone Number	:	910-278-3268
Fax Number	:	910-278-3305

Provider Business Practice Location Address
First Line	:	8212 E OAK ISLAND DR
Second Line	:
City	:	OAK ISLAND
State	:	NC
Zip	:	28465-8057
Country	:	US
Telephone Number	:	910-278-3268
Fax Number	:	910-278-3305

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

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	05/18/2011

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