Active NPI
Miles Lee Renick, DMD
- General Practice Dentistry
- Fort Eustis, VA
National Provider Identifier
1780060772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 9654
- Practice address
- 669 Monroe Ave
Fort Eustis, VA 23604-5005 - Phone
- (239) 314-8016
- NPI assigned
- Aug 3, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9654 | KY | |
| General Practice Dentistry | 1223G0001X | 9654 | KY | Primary |
Addresses
Primary practice location
669 Monroe Ave
Fort Eustis, VA 23604-5005
Mailing address
US Army Dental Health Activity Bavaria
CMR 411 Unit 28038
Apo, AE 09112
Other practice location 1
4323 Hill St
Columbia, SC 29207-6022
Phone (803) 751-6209
Other practice location 2
US Army Dental Health Activity Bavaria
CMR 411 Unit 28038
Apo, AE 09112
Phone (314) 590-3980
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9654 | KY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688947200000",
"number": "1780060772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "MIL",
"address_1": "US ARMY DENTAL HEALTH ACTIVITY BAVARIA",
"address_2": "CMR 411 UNIT 28038",
"city": "APO",
"state": "AE",
"postal_code": "09112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "669 MONROE AVE",
"city": "FORT EUSTIS",
"state": "VA",
"postal_code": "236045005",
"telephone_number": "239-314-8016"
}
],
"practiceLocations": [
{
"address_1": "4323 Hill St",
"address_purpose": "LOCATION",
"city": "Columbia",
"state": "SC",
"postal_code": "292076022",
"country_code": "US",
"telephone_number": "803-751-6209",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "US Army Dental Health Activity Bavaria",
"address_2": "CMR 411 Unit 28038",
"address_purpose": "LOCATION",
"city": "APO",
"state": "AE",
"postal_code": "09112",
"country_code": "US",
"telephone_number": "314-590-3980",
"country_name": "United States",
"address_type": "MIL"
}
],
"basic": {
"last_name": "RENICK",
"first_name": "MILES",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-03",
"last_updated": "2023-07-10",
"certification_date": "2023-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "9654",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KY",
"license": "9654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Eustis, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.