Provider Demographics
NPI:1215364005
Name:STEPHANIE MYLES PC
Entity Type:Organization
Organization Name:STEPHANIE MYLES PC
Other - Org Name:MYLES FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYLES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-716-0544
Mailing Address - Street 1:PO BOX 12127
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-0107
Mailing Address - Country:US
Mailing Address - Phone:412-716-0544
Mailing Address - Fax:
Practice Address - Street 1:404 S COLLEGE RD
Practice Address - Street 2:SUITE 44
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1604
Practice Address - Country:US
Practice Address - Phone:412-716-0544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty