Provider Demographics
NPI:1306395272
Name:MILES, AUDREY WORTHINGTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:WORTHINGTON
Last Name:MILES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6044 E LOVERS LN
Mailing Address - Street 2:APT 7109
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4371
Mailing Address - Country:US
Mailing Address - Phone:785-550-2280
Mailing Address - Fax:
Practice Address - Street 1:6044 E LOVERS LN
Practice Address - Street 2:APT 7109
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4371
Practice Address - Country:US
Practice Address - Phone:785-550-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist