Healthcare Provider Details

I. General information

NPI: 1114901428
Provider Name (Legal Business Name): ALLISON ANN MILLINER D.D.S, M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 S CLEMENTINE ST
OCEANSIDE CA
92054-4105
US

IV. Provider business mailing address

802 S CLEMENTINE ST
OCEANSIDE CA
92054-4105
US

V. Phone/Fax

Practice location:
  • Phone: 773-354-4991
  • Fax:
Mailing address:
  • Phone: 773-354-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number56309
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD008574
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: