Provider Demographics
NPI:1467818302
Name:MILES, ALLISON (RDH)
Entity Type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3985
Mailing Address - Country:US
Mailing Address - Phone:541-993-7110
Mailing Address - Fax:
Practice Address - Street 1:501 E 7TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2677
Practice Address - Country:US
Practice Address - Phone:541-298-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7050124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist