MEDICARE: DANIELLE MILLER

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	1223P0221X	Pediatric Dentistry	0401416210	VA

General Provider Information

NPI Number	:	1952897050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE MILLER

Provider Business Mailing Address
First Line	:	11934 W BROAD ST STE 120
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-1100
Country	:	US
Telephone Number	:	804-746-7382
Fax Number	:

Provider Business Practice Location Address
First Line	:	11934 W BROAD ST STE 120
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-1100
Country	:	US
Telephone Number	:	804-746-7382
Fax Number	:

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

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	09/01/2020

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Directions to “ DANIELLE MILLER ” Practice Location

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