Provider Demographics
NPI:1063563724
Name:MILES, KENNETH CHESTER (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHESTER
Last Name:MILES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 MONACO DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-7807
Mailing Address - Country:US
Mailing Address - Phone:586-484-2014
Mailing Address - Fax:
Practice Address - Street 1:1140 PRATT BLVD
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4405
Practice Address - Country:US
Practice Address - Phone:863-674-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHAD1001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104312600Medicaid