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NPI Code Detail

MEDICARE: DR. AMBROSE MILLER MARTIN III D.D.S.

MEDICARE: DR. AMBROSE MILLER MARTIN III 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
11223G0001XGeneral Practice Dentistry4671LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1970847OTHERLAUNITED CONCORDIA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649305814
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMBROSE MILLER MARTIN III D.D.S.
Provider Business Mailing Address
First Line : 2610 ESPLANADE AVE
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70119-3321
Country : US
Telephone Number : 504-482-9919
Fax Number : 504-482-9921
Provider Business Practice Location Address
First Line : 2610 ESPLANADE AVE
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70119-3321
Country : US
Telephone Number : 504-482-9919
Fax Number : 504-482-9921
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2007
Last Update Date : 07/08/2007

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