Provider Demographics
NPI:1205191020
Name:MILES, JOSHUA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:MILES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 BUCHANAN DR
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-2301
Mailing Address - Country:US
Mailing Address - Phone:512-756-4176
Mailing Address - Fax:512-756-7752
Practice Address - Street 1:603 BUCHANAN DR
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-2301
Practice Address - Country:US
Practice Address - Phone:512-756-4176
Practice Address - Fax:512-756-7752
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29453122300000X
IDD-4436122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist