Provider Demographics
NPI:1639357254
Name:MILES, BRIAN D (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:MILES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5640 WASATCH DR
Mailing Address - Street 2:STE. A
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4902
Mailing Address - Country:US
Mailing Address - Phone:801-479-6590
Mailing Address - Fax:801-479-6755
Practice Address - Street 1:5640 WASATCH DR
Practice Address - Street 2:STE. A
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4902
Practice Address - Country:US
Practice Address - Phone:801-479-6590
Practice Address - Fax:801-479-6755
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6872175-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice