MEDICARE: DR. JEROLD WARREN MILLER 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
1	122300000X	Dentist	DS014614L	PA

General Provider Information

NPI Number	:	1811104136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROLD WARREN MILLER D.D.S.

Provider Business Mailing Address
First Line	:	1845 WALNUT ST
Second Line	:	SUITE 950
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4708
Country	:	US
Telephone Number	:	215-567-0110
Fax Number	:	215-864-0496

Provider Business Practice Location Address
First Line	:	1845 WALNUT ST
Second Line	:	SUITE 950
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4708
Country	:	US
Telephone Number	:	215-567-0110
Fax Number	:	215-864-0496

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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