Provider Demographics
NPI:1871708339
Name:GUYTON, MILES ALEXANDER (DDS)
Entity type:Individual
Prefix:
First Name:MILES
Middle Name:ALEXANDER
Last Name:GUYTON
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 1:4125 BLACKFORD AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1701
Mailing Address - Country:US
Mailing Address - Phone:408-248-1467
Mailing Address - Fax:
Practice Address - Street 1:4125 BLACKFORD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1701
Practice Address - Country:US
Practice Address - Phone:408-248-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist