Provider Demographics
NPI:1760951214
Name:MILES OF SMILES DENTISTRY
Entity Type:Organization
Organization Name:MILES OF SMILES DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:DELANO
Authorized Official - Last Name:WHEATON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-308-5086
Mailing Address - Street 1:5621 LESLIE CT.
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504
Mailing Address - Country:US
Mailing Address - Phone:810-308-0586
Mailing Address - Fax:
Practice Address - Street 1:5621 LESLIE CT
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504
Practice Address - Country:US
Practice Address - Phone:810-308-0586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty