Individual
AMANDA MILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DHAT
Contact information
Practice address
3449 E. REZANOF DRIVE, DENTAL DEPARTMENT, KODIAK, AK 99615-3449
(907) 486-9850
Mailing address
3449 E. REZANOF DRIVE, DENTAL DEPARTMENT, KODIAK, AK 99615-3449
(907) 539-6717
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
247200000X
AK
Other
Enumeration date
06/25/2015
Last updated
06/25/2015
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