Provider Demographics
NPI:1033299334
Name:MILES, JEFFREY P (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:MILES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 E IL ROUTE 173
Mailing Address - Street 2:SUITE 113
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-9407
Mailing Address - Country:US
Mailing Address - Phone:847-395-5550
Mailing Address - Fax:847-395-5575
Practice Address - Street 1:417 E IL ROUTE 173
Practice Address - Street 2:SUITE 113
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-9407
Practice Address - Country:US
Practice Address - Phone:847-395-5550
Practice Address - Fax:847-395-5575
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0255951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice