Provider Demographics
NPI:1003045246
Name:MILES DENTAL CARE
Entity Type:Organization
Organization Name:MILES DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-370-1314
Mailing Address - Street 1:6263 MCCART AVE
Mailing Address - Street 2:201
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-4200
Mailing Address - Country:US
Mailing Address - Phone:817-370-1314
Mailing Address - Fax:817-370-1344
Practice Address - Street 1:6263 MCCART AVE
Practice Address - Street 2:201
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-4200
Practice Address - Country:US
Practice Address - Phone:817-370-1314
Practice Address - Fax:817-370-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14,2221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty