Healthcare Provider Details

I. General information

NPI: 1578550182
Provider Name (Legal Business Name): KRYSTAL J. MILES D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7225 N ORACLE RD STE 201
TUCSON AZ
85704-6322
US

IV. Provider business mailing address

7225 N ORACLE RD STE 201
TUCSON AZ
85704-6322
US

V. Phone/Fax

Practice location:
  • Phone: 520-229-9000
  • Fax: 520-229-9011
Mailing address:
  • Phone: 520-229-9000
  • Fax: 520-229-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD4173
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: