Provider Demographics
NPI:1346320819
Name:MILES, JOSEPH PRUETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PRUETT
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 1:511 N HYATT ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-4029
Mailing Address - Country:US
Mailing Address - Phone:870-367-6453
Mailing Address - Fax:870-367-0375
Practice Address - Street 1:511 N HYATT ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4029
Practice Address - Country:US
Practice Address - Phone:870-367-6453
Practice Address - Fax:870-367-0375
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S902OtherBCBS FEDERAL
AR847904OtherUNITED CONCORDIA