Provider Demographics
NPI:1306980586
Name:PREBLE, MYLES A (DMD)
Entity type:Individual
Prefix:MR
First Name:MYLES
Middle Name:A
Last Name:PREBLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3311 N. UNIVERSITY AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-655-1801
Mailing Address - Fax:801-590-0504
Practice Address - Street 1:3311 N. UNIVERSITY AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-655-1801
Practice Address - Fax:801-590-0504
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1417521223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice