Provider Demographics
NPI:1083800783
Name:MILLER, GREG CHARLES (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:CHARLES
Last Name:MILLER
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:4301 ATLANTIC AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2833
Mailing Address - Country:US
Mailing Address - Phone:562-427-1426
Mailing Address - Fax:562-427-4406
Practice Address - Street 1:4301 ATLANTIC AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2833
Practice Address - Country:US
Practice Address - Phone:562-427-1426
Practice Address - Fax:562-427-4406
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2009-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA556991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics