Provider Demographics
NPI:1346831526
Name:MILES, TIFFANY ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ELIZABETH
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 1:2245 S BEVERLY GLEN BLVD APT 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2439
Mailing Address - Country:US
Mailing Address - Phone:281-770-8429
Mailing Address - Fax:
Practice Address - Street 1:4542 SPRING STUEBNER RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-4633
Practice Address - Country:US
Practice Address - Phone:281-376-2706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX375321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program