Provider Demographics
NPI:1851768360
Name:GREG MILLER, DDS, INC
Entity Type:Organization
Organization Name:GREG MILLER, DDS, INC
Other - Org Name:MARIN BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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 1:1730 NOVATO BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3048
Mailing Address - Country:US
Mailing Address - Phone:415-897-4191
Mailing Address - Fax:
Practice Address - Street 1:1730 NOVATO BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-3048
Practice Address - Country:US
Practice Address - Phone:415-897-4191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556991223X0400X
CA530021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty