Healthcare Provider Details

I. General information

NPI: 1821087032
Provider Name (Legal Business Name): GREGORY JONATHAN MILLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7723 ALASKA AVE NW
WASHINGTON DC
20012-1458
US

IV. Provider business mailing address

9223 QUINTANA DR
BETHESDA MD
20817-2001
US

V. Phone/Fax

Practice location:
  • Phone: 202-882-7878
  • Fax: 202-882-4948
Mailing address:
  • Phone: 301-365-2606
  • Fax: 301-365-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN4342
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: