Provider Demographics
NPI:1346922390
Name:MYLES, MAKAYLA (DDS)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:
Last Name:MYLES
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 1:212 BLUE SKY DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7341
Mailing Address - Country:US
Mailing Address - Phone:504-920-9192
Mailing Address - Fax:
Practice Address - Street 1:9880 ROCKY RIVER RD
Practice Address - Street 2:STE A
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075
Practice Address - Country:US
Practice Address - Phone:704-954-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC134211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice