MEDICARE: DR. MATTHEW S MILLER DMD

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	DS038872	PA

General Provider Information

NPI Number	:	1649520933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW S MILLER DMD

Provider Business Mailing Address
First Line	:	14TH MEDICAL GROUP 201 INDEPENDENCE DRIVE
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39710-0001
Country	:	US
Telephone Number	:	662-434-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	14TH MEDICAL GROUP
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39710-0001
Country	:	US
Telephone Number	:	662-434-2273
Fax Number	:

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

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	02/04/2025

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