MEDICARE: WILLIAM B MILLER DMD PC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN009183	GA

General Provider Information

NPI Number	:	1881813772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM B MILLER DMD PC

Provider Business Mailing Address
First Line	:	104 OLD MILL RD
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-6704
Country	:	US
Telephone Number	:	706-884-0049
Fax Number	:	706-884-2634

Provider Business Practice Location Address
First Line	:	104 OLD MILL RD
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-6704
Country	:	US
Telephone Number	:	706-884-0049
Fax Number	:	706-884-2634

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. WILLIAM BRUCE MILLER
Credential	:	D.M.D.
Telephone Number	:	706-884-0049

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	05/28/2015

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