MEDICARE: S&S MILLER RD, LLC

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

General Provider Information

NPI Number	:	1821205543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S&S MILLER RD, LLC

Provider Business Mailing Address
First Line	:	326 TOM MILLER RD
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-6430
Country	:	US
Telephone Number	:	518-563-7097
Fax Number	:	518-563-9690

Provider Business Practice Location Address
First Line	:	326 TOM MILLER RD
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-6430
Country	:	US
Telephone Number	:	518-563-7097
Fax Number	:	518-563-9690

Authorized Official
Title or Position	:	REGIONAL MANAGER
Name	:	MISS LAUREN M SIMPSON
Credential	:
Telephone Number	:	518-536-1261

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	02/23/2017

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