Provider Demographics
NPI:1336526607
Name:GREG MILLER, DDS, INC.
Entity type:Organization
Organization Name:GREG MILLER, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:562-900-9263
Mailing Address - Street 1:81 GREGORY LN
Mailing Address - Street 2:240
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3386
Mailing Address - Country:US
Mailing Address - Phone:925-322-0005
Mailing Address - Fax:
Practice Address - Street 1:81 GREGORY LN
Practice Address - Street 2:240
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3386
Practice Address - Country:US
Practice Address - Phone:925-322-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55699OtherDENTAL LICENSE