Provider Demographics
NPI:1578550182
Name:MILES, KRYSTAL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:J
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 1:7225 N ORACLE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6322
Mailing Address - Country:US
Mailing Address - Phone:520-229-9000
Mailing Address - Fax:520-229-9011
Practice Address - Street 1:7225 N ORACLE RD
Practice Address - Street 2:STE 201
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6322
Practice Address - Country:US
Practice Address - Phone:520-229-9000
Practice Address - Fax:520-229-9011
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD41731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics