Healthcare Provider Details

I. General information

NPI: 1386779643
Provider Name (Legal Business Name): NEELU S MILAK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BATA BLVD SUITE D
BELCAMP MD
21017-1431
US

IV. Provider business mailing address

111 BATA BLVD SUITE D
BELCAMP MD
21017-1431
US

V. Phone/Fax

Practice location:
  • Phone: 410-272-1535
  • Fax:
Mailing address:
  • Phone: 410-272-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. NEELU MILAK
Title or Position: OWNER
Credential: D.D.S.
Phone: 410-939-3343