Matthew Braden Burns Miller, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

12339 Issued in CT

Practice address

1 Wahoo Ave
Groton, CT 06349

Phone

(860) 694-3094

NPI assigned

Oct 4, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571184000000",
    "number": "1043207004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 SOMERSET LN",
            "city": "OLD LYME",
            "state": "CT",
            "postal_code": "063711737",
            "telephone_number": "301-775-4866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WAHOO AVE",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "06349",
            "telephone_number": "860-694-3094"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1253 Makalapa Gate Rd",
            "address_purpose": "LOCATION",
            "city": "Pearl Harbor",
            "state": "HI",
            "postal_code": "968604479",
            "country_code": "US",
            "telephone_number": "808-473-0495 x436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "MATTHEW",
        "middle_name": "BRADEN BURNS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2019-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00009227",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CT",
            "license": "12339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shayla Marie Michel, LMFT
• Michelle Bussolotti, LMFT
• Nicholas Mihalecz, IDC
• Eleni Milas, D.M.D.
• Jennette Miller
• Renay Miller, BSC(PHARMACY)
• Dawn Mingione, M.S. CCC-SLP
• Matthew John Mitchell, IDC
• Mark William Mittauer, MD
• Edward Thomas Moldenhauer, RPH (MS BPHARM)

• Periodontics in Groton, CT
• Providers in Groton, CT by specialty
• Periodontics in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.