Provider Demographics
NPI:1386058238
Name:MILES, MAHOGANY (DMD)
Entity type:Individual
Prefix:DR
First Name:MAHOGANY
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:WAINSCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:11975-0528
Mailing Address - Country:US
Mailing Address - Phone:631-537-1505
Mailing Address - Fax:
Practice Address - Street 1:384 MONTAUK HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:WAINSCOTT
Practice Address - State:NY
Practice Address - Zip Code:11975-2000
Practice Address - Country:US
Practice Address - Phone:631-537-1505
Practice Address - Fax:631-537-1577
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0572481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics