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General NPI Number Information
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NPI Number | 1346560547
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Entity Type | Organization
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Legal Business Name | MILLER AND KAN, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 4301 ATLANTIC AVE SUITE 2
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City | LONG BEACH
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State | CA
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Zip | 90807-2833
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Country | US
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Telephone | 562-427-1426
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Fax | 562-427-4406
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Provider Business Mailing Address
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Address Line | 4301 ATLANTIC AVE SUITE 2
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City | LONG BEACH
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State | CA
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Zip | 90807-2833
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Country | US
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Telephone | 562-427-1426
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Fax | 562-427-4406
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. GREG CHARLES MILLER
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Credential | D.D.S.
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Telephone | 562-427-1426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 53002
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 55699
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License Number State | CA
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