MEDICARE: DR. CORBIN DAVID MILENBAUGH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22026	TX

General Provider Information

NPI Number	:	1831211366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORBIN DAVID MILENBAUGH DDS

Provider Business Mailing Address
First Line	:	1420 BONHAM PKWY
Second Line	:
City	:	LANTANA
State	:	TX
Zip	:	76226-6436
Country	:	US
Telephone Number	:	972-977-9951
Fax Number	:

Provider Business Practice Location Address
First Line	:	6332 LAKE WORTH BLVD
Second Line	:
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-3602
Country	:	US
Telephone Number	:	817-237-3222
Fax Number	:	817-237-0101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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