Samuel Paul Miano Jr., D.D.S., L.L.C.
Individual provider Active NPI General Practice Dentistry · Reserve, LA
NPI 1104956762 · NPPES record last updated Nov 1, 2009
Key facts
- NPI
- 1104956762
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4090 (LA)
- Practice address
- 674 Central Ave
Reserve, LA 70084-5514 - Phone
- (985) 536-3455
- Fax
- (985) 536-8865
- NPI assigned
- Mar 6, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170428000766 | LA | Order and Referring Only - Dentist |
3577840545 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4090 | LA | MD | General Practice Dentistry |
Networks
- LA PPO C-SNP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4090 | LA | Yes |
Addresses
Primary practice location
674 Central Ave
Reserve, LA 70084-5514
Mailing address
674 Central Ave
Reserve, LA 70084-5514
Phone (985) 536-3455
Other providers in Reserve, LA
- Natalie Larose
- Haley Rose Leblanc
- Megan Neal Legendre
- Denija Linton
- Brett David Madere
- Jnai Mickens
- Maia G Miller
- Terri Millet
- Randy Mire
- Sedera Montgomery
All providers in Reserve, LA · General Practice Dentistry in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.