Healthcare Provider Details

I. General information

NPI: 1366996100
Provider Name (Legal Business Name): STEVEN JEFFREY MILES D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3378 S MURLO WAY
MERIDIAN ID
83642-4847
US

IV. Provider business mailing address

3378 S MURLO WAY
MERIDIAN ID
83642-4847
US

V. Phone/Fax

Practice location:
  • Phone: 208-680-0522
  • Fax:
Mailing address:
  • Phone: 208-680-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberD-DA-5395
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number0401418594
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: