Provider Demographics
NPI:1871684175
Name:MILLER, RONALD GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GEORGE
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 1:1409 N TRACY BLVD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3445
Mailing Address - Country:US
Mailing Address - Phone:209-835-5116
Mailing Address - Fax:209-835-5093
Practice Address - Street 1:1409 N TRACY BLVD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3445
Practice Address - Country:US
Practice Address - Phone:209-835-5116
Practice Address - Fax:209-835-5093
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA394491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice