Provider Demographics
NPI:1417474321
Name:MILES, TATUM (DDS)
Entity Type:Individual
Prefix:DR
First Name:TATUM
Middle Name:
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 1:12430 OXFORD PARK DR APT 516
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2576
Mailing Address - Country:US
Mailing Address - Phone:313-525-6366
Mailing Address - Fax:
Practice Address - Street 1:12430 OXFORD PARK DR APT 516
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2576
Practice Address - Country:US
Practice Address - Phone:313-525-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104195122300000X
MI29010224241223G0001X
TX36061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice