Provider Demographics
NPI:1003800137
Name:MIYAKE, GREGORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:MIYAKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7234 N SEQUOIA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0450
Mailing Address - Country:US
Mailing Address - Phone:559-246-4195
Mailing Address - Fax:559-447-1813
Practice Address - Street 1:7234 N SEQUOIA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0450
Practice Address - Country:US
Practice Address - Phone:559-246-4195
Practice Address - Fax:559-447-1813
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-05
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice