Provider Demographics
NPI:1093941627
Name:MILES, JANE MIRANDA (BA, BS, RDH)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:MIRANDA
Last Name:MILES
Suffix:
Gender:F
Credentials:BA, BS, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 23436
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-3436
Mailing Address - Country:US
Mailing Address - Phone:501-519-7645
Mailing Address - Fax:
Practice Address - Street 1:312 SHORT STREET
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015
Practice Address - Country:US
Practice Address - Phone:501-519-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1835124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1194770362OtherNPI