Healthcare Provider Details

I. General information

NPI: 1003975640
Provider Name (Legal Business Name): TOM J MILIUS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 N 83RD ST
LINCOLN NE
68505-2080
US

IV. Provider business mailing address

1140 N 83RD ST
LINCOLN NE
68505-2080
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-4322
  • Fax: 402-483-0439
Mailing address:
  • Phone: 402-483-4322
  • Fax: 402-483-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6514
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: