Provider Demographics
NPI:1609499169
Name:HOLLINSHED-MILES, TANYA TAMIKI (DDS)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:TAMIKI
Last Name:HOLLINSHED-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 1:1304 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36113-1002
Mailing Address - Country:US
Mailing Address - Phone:404-326-9886
Mailing Address - Fax:
Practice Address - Street 1:1304 BEECH ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36113-1002
Practice Address - Country:US
Practice Address - Phone:404-326-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist