Provider Demographics
NPI:1467616706
Name:HUMBLE, MILES COLMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:COLMAN
Last Name:HUMBLE
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 1:240 CHATTANOOGA ST APT 25
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3402
Mailing Address - Country:US
Mailing Address - Phone:719-357-0006
Mailing Address - Fax:
Practice Address - Street 1:240 CHATTANOOGA ST APT 25
Practice Address - Street 2:ISLAND DENTAL
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3402
Practice Address - Country:US
Practice Address - Phone:719-357-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist