Provider Demographics
NPI:1962605675
Name:MILES, ETHEL MARLENE (DDS)
Entity type:Individual
Prefix:DR
First Name:ETHEL
Middle Name:MARLENE
Last Name:MILES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ETHEL
Other - Middle Name:MARLENE
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5 FISCELLA CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-1865
Mailing Address - Country:US
Mailing Address - Phone:757-851-5549
Mailing Address - Fax:757-851-5549
Practice Address - Street 1:425 W 20TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2128
Practice Address - Country:US
Practice Address - Phone:757-622-4245
Practice Address - Fax:757-622-3722
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401 0068231223G0001X
NY500534771223G0001X
UT632262099211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice