Individual provider Active NPI

Anthony Reed Miller, DMD

  • Dentist
  • Middleburg, FL
National Provider Identifier
1417363904
Registry record updated Nov 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN20741 Issued in FL
Practice address
1776 Blanding Blvd
Middleburg, FL 32068-3836
Phone
(904) 203-2335
Fax
(904) 406-9739
NPI assigned
Jul 7, 2014
Last updated
Nov 4, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN20741 FL Primary

Addresses

Primary practice location

1776 Blanding Blvd
Middleburg, FL 32068-3836

Mailing address

1776 Blanding Blvd
Middleburg, FL 32068-3836
Phone (904) 203-2335

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160414000423 FL Order and Referring Only - DentistPractitioner - Dentist 1951609593

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN20741FLMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Comfortable Care Dental Health Professionals, PA Dentist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478217600000",
    "number": "1417363904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 BLANDING BLVD",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320683836",
            "telephone_number": "904-203-2335",
            "fax_number": "904-406-9739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1776 BLANDING BLVD",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320683836",
            "telephone_number": "904-203-2335",
            "fax_number": "904-406-9739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "ANTHONY",
        "middle_name": "REED",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-07",
        "last_updated": "2016-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN20741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middleburg, FL

Sources for this page

Verify at the official NPI Registry.