Provider Demographics
NPI:1669809042
Name:MILES DENTAL
Entity type:Organization
Organization Name:MILES DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-502-1800
Mailing Address - Street 1:8301 WHITLEY RD
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2483
Mailing Address - Country:US
Mailing Address - Phone:817-502-1800
Mailing Address - Fax:
Practice Address - Street 1:8301 WHITLEY RD
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2483
Practice Address - Country:US
Practice Address - Phone:817-502-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty