Provider Demographics
NPI:1639250095
Name:MILLER, GREG W (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:W
Last Name:MILLER
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 1:19421 N YALE RD
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-9338
Mailing Address - Country:US
Mailing Address - Phone:509-238-4023
Mailing Address - Fax:509-276-8899
Practice Address - Street 1:20 EAST J STREET
Practice Address - Street 2:SUITE 2B
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006
Practice Address - Country:US
Practice Address - Phone:509-276-8999
Practice Address - Fax:509-276-8899
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009853122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist