Healthcare Provider Details

I. General information

NPI: 1578096939
Provider Name (Legal Business Name): SHAI HALL MILES, DDS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2729 ROSS CLARK CIR
DOTHAN AL
36301-3214
US

IV. Provider business mailing address

2729 ROSS CLARK CIR
DOTHAN AL
36301-3214
US

V. Phone/Fax

Practice location:
  • Phone: 334-702-0667
  • Fax:
Mailing address:
  • Phone: 334-702-0667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: SHAI HALL
Title or Position: PRACTICE OWNER
Credential:
Phone: 334-702-0667