Healthcare Provider Details

I. General information

NPI: 1225193949
Provider Name (Legal Business Name): JOHN SAMUEL MILEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44539 STERLING HWY 203
SOLDOTNA AK
99669-7938
US

IV. Provider business mailing address

863 RIVER ESTATES DR
SOLDOTNA AK
99669-8067
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-8834
  • Fax:
Mailing address:
  • Phone: 907-262-8834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1020
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: