MEDICARE: DR. ROBERT B. 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	1223G0001X	General Practice Dentistry	11307	MN

General Provider Information

NPI Number	:	1841365293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT B. MILLER DDS

Provider Business Mailing Address
First Line	:	17746 KENWOOD TRL
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-9454
Country	:	US
Telephone Number	:	952-388-1778
Fax Number	:	952-388-1778

Provider Business Practice Location Address
First Line	:	17746 KENWOOD TRL
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-9454
Country	:	US
Telephone Number	:	952-388-1778
Fax Number	:	952-388-1778

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	09/08/2011

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