Healthcare Provider Details

I. General information

NPI: 1871684175
Provider Name (Legal Business Name): RONALD GEORGE MILLER D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 N. TRACY BLVD
TRACY CA
95376-3445
US

IV. Provider business mailing address

1407 N. TRACY BLVD
TRACY CA
95376-3445
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-5116
  • Fax: 209-835-8093
Mailing address:
  • Phone: 209-835-5116
  • Fax: 209-835-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: