Healthcare Provider Details

I. General information

NPI: 1760962252
Provider Name (Legal Business Name): IAN ALEXANDER MILTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RAF LAKENHEATH 48 MDG/SCHC UNIT 5115
APO AE
09461-5115
US

IV. Provider business mailing address

PSC 41 BOX 5277
APO AE
09464-0053
US

V. Phone/Fax

Practice location:
  • Phone: 163-852-8124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401415766
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: