=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235147174
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD E MILEHAM DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29050 S WESTERN AVE #108
-----------------------------------------------------
City | RANCHO PALOS VERDES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90275-0820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-547-0700
-----------------------------------------------------
Fax | 310-547-2587
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29050 S WESTERN AVE #108
-----------------------------------------------------
City | RANCHO PALOS VERDES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90275-0820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-547-0700
-----------------------------------------------------
Fax | 310-547-2587
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RONALD E MILEHAM
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 310-547-0700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 23350
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------