Provider Demographics
NPI:1932322427
Name:MILES, MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MILES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 STEWART AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4170
Mailing Address - Country:US
Mailing Address - Phone:715-842-4440
Mailing Address - Fax:715-842-5977
Practice Address - Street 1:2620 STEWART AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4170
Practice Address - Country:US
Practice Address - Phone:715-842-4440
Practice Address - Fax:715-842-5977
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001946 - 0151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics