MEDICARE: MILLENNIUM DENTISTRY PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1932831658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	16800 W 12 MILE RD STE 103
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-6335
Country	:	US
Telephone Number	:	248-352-4789
Fax Number	:	248-352-4825

Provider Business Practice Location Address
First Line	:	16800 W 12 MILE RD STE 103
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-6335
Country	:	US
Telephone Number	:	248-352-4789
Fax Number	:	248-352-4825

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. EUGENIA ADLAI
Credential	:	DDS
Telephone Number	:	248-880-1093

Provider Enumeration Date	:	06/30/2022
Last Update Date	:	06/30/2022

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