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General NPI Number Information
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NPI Number | 1770402893
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Entity Type | Organization
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Legal Business Name | SURFSIDE COLLECTIVE INC.
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Dates
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Enumeration Date | 07/13/2026
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 23601 CRENSHAW BLVD
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City | TORRANCE
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State | CA
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Zip | 90505-5204
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Country | US
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Telephone | 424-538-4752
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 N SEPULVEDA BLVD # 354
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-5111
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Country | US
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Telephone | 503-886-9635
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN MILLER
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Credential | DDS
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Telephone | 503-886-9635
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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 |
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License Number State |
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