Provider Demographics
NPI:1972712842
Name:MILES, BRETT (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:MILES
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 EAST 77TH STREET
Mailing Address - Street 2:BLACK HALL, 10TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075
Mailing Address - Country:US
Mailing Address - Phone:212-434-4500
Mailing Address - Fax:
Practice Address - Street 1:130 EAST 77TH ST
Practice Address - Street 2:BLACK HALL, 10TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075
Practice Address - Country:US
Practice Address - Phone:212-434-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196931223S0112X
NY256745-1207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176986101Medicaid