Provider Demographics
NPI:1942351606
Name:STANLEY MILLER DDS, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:STANLEY MILLER DDS, PROFESSIONAL CORPORATION
Other - Org Name:DENTAL WORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-769-0466
Mailing Address - Street 1:6350 W RAMSEY ST
Mailing Address - Street 2:SUITE #A
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-3062
Mailing Address - Country:US
Mailing Address - Phone:951-769-0466
Mailing Address - Fax:951-769-3606
Practice Address - Street 1:6350 W RAMSEY ST
Practice Address - Street 2:SUITE #A
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3062
Practice Address - Country:US
Practice Address - Phone:951-769-0466
Practice Address - Fax:951-769-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9167801Medicaid
CA000043640CAOtherDELTA DENTAL