Provider Demographics
NPI:1851622187
Name:MILES FAMILY DENTAL
Entity Type:Organization
Organization Name:MILES FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-395-5550
Mailing Address - Street 1:417 E IL ROUTE 173
Mailing Address - Street 2:SUITE 113
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002
Mailing Address - Country:US
Mailing Address - Phone:847-395-5550
Mailing Address - Fax:847-395-5575
Practice Address - Street 1:417 E IL ROUTE 173
Practice Address - Street 2:SUITE 113
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002
Practice Address - Country:US
Practice Address - Phone:847-395-5550
Practice Address - Fax:847-395-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty