Provider Demographics
NPI:1699926907
Name:MYLES, WAYNE SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:SCOTT
Last Name:MYLES
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 1:11730 PLAZA AMERICA DR STE 110
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4749
Mailing Address - Country:US
Mailing Address - Phone:703-925-0800
Mailing Address - Fax:
Practice Address - Street 1:11730 PLAZA AMERICA DR STE 110
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4749
Practice Address - Country:US
Practice Address - Phone:703-925-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA7524122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist