Healthcare Provider Details

I. General information

NPI: 1669809042
Provider Name (Legal Business Name): MILES DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 WHITLEY RD
WATAUGA TX
76148-2483
US

IV. Provider business mailing address

8301 WHITLEY RD
WATAUGA TX
76148-2483
US

V. Phone/Fax

Practice location:
  • Phone: 817-502-1800
  • Fax:
Mailing address:
  • Phone: 817-502-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BILLY WAYNE MILES
Title or Position: DENTIST
Credential: D.D.S
Phone: 817-502-1800