MEDICARE: KRISTA LEIGH MILLER

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	124Q00000X	Dental Hygienist	6861	GA
2	124Q00000X	Dental Hygienist
3	124Q00000X	Dental Hygienist	17269	TX

General Provider Information

NPI Number	:	1730694134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA LEIGH MILLER

Provider Business Mailing Address
First Line	:	8439 APACHE BND
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-2313
Country	:	US
Telephone Number	:	912-230-1709
Fax Number	:

Provider Business Practice Location Address
First Line	:	10003 NW MILITARY HWY STE 3209
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-1892
Country	:	US
Telephone Number	:	210-979-0707
Fax Number	:

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

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	12/06/2017

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Directions to “ KRISTA LEIGH MILLER ” Practice Location

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