Provider Demographics
NPI:1528541752
Name:TODD C MILES LLC DBA DELANEY PARK DENTAL
Entity Type:Organization
Organization Name:TODD C MILES LLC DBA DELANEY PARK DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GARRABRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-276-7787
Mailing Address - Street 1:880 N ST STE 301
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3276
Mailing Address - Country:US
Mailing Address - Phone:907-276-7787
Mailing Address - Fax:907-258-1685
Practice Address - Street 1:880 N ST STE 301
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3276
Practice Address - Country:US
Practice Address - Phone:907-276-7787
Practice Address - Fax:907-258-1685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELANEY PARK DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK122989OtherSTATE LICENSE