Provider Demographics
NPI:1235147174
Name:RONALD E MILEHAM DDS INC
Entity Type:Organization
Organization Name:RONALD E MILEHAM DDS INC
Other - Org Name:SOUTH BAY CENTER FOR AESTHETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILEHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-547-0700
Mailing Address - Street 1:29050 S WESTERN AVE
Mailing Address - Street 2:#108
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-0820
Mailing Address - Country:US
Mailing Address - Phone:310-547-0700
Mailing Address - Fax:310-547-2587
Practice Address - Street 1:29050 S WESTERN AVE
Practice Address - Street 2:#108
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0820
Practice Address - Country:US
Practice Address - Phone:310-547-0700
Practice Address - Fax:310-547-2587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23350122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty