John W Miller, DMD
Individual provider Active NPI Dentist · Edmonton, KY
NPI 1629148481 · NPPES record last updated Jun 19, 2008
Key facts
- NPI
- 1629148481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 8177 (KY)
- Practice address
- 108 Elmore Street
Edmonton, KY 42129 - Phone
- (270) 432-7211
- Fax
- (270) 432-7215
- NPI assigned
- Nov 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- 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 |
|---|---|---|---|---|
| I20151203001439 | KY | Order and Referring Only - Dentist |
5395045934 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8177 | KY | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8177 | KY | Yes |
| General Practice Dentistry | 1223G0001X | 8177 | KY |
Addresses
Primary practice location
108 Elmore Street
Edmonton, KY 42129
Mailing address
PO Box 269
Edmonton, KY 42129
Phone (270) 432-7211
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 45003621 | Medicaid | KY | |
| 60003035 | Medicaid | KY |
Other providers in Edmonton, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 2008. 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.