MEDICARE: JD MILLER DDS 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	D9312	OR

General Provider Information

NPI Number	:	1891208724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JD MILLER DDS PC

Provider Business Mailing Address
First Line	:	2250 NW FLANDERS ST STE 112
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-5409
Country	:	US
Telephone Number	:	503-944-9374
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 NW FLANDERS ST STE 112
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-5409
Country	:	US
Telephone Number	:	503-944-9374
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN DAVID MILLER
Credential	:	DDS
Telephone Number	:	503-944-9374

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	11/14/2017

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