MEDICARE: DR. MATTHEW 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	122300000X	Dentist	08481	IA
2	122300000X	Dentist	8472	SC

General Provider Information

NPI Number	:	1700046406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW MILLER DDS

Provider Business Mailing Address
First Line	:	2700 BROAD RIVER RD
Second Line	:	SUITE L
City	:	COLUMBIA
State	:	SC
Zip	:	29210-6055
Country	:	US
Telephone Number	:	803-772-4949
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 BROAD RIVER RD
Second Line	:	SUITE L
City	:	COLUMBIA
State	:	SC
Zip	:	29210-6055
Country	:	US
Telephone Number	:	803-772-4949
Fax Number	:

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

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	05/27/2015

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