Healthcare Provider Details

I. General information

NPI: 1255439808
Provider Name (Legal Business Name): SCOTT MILTENBURGER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 INDIAN SCHOOL RD NE SUITE 201
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

3901 GEORGIA ST NE STE C4
ALBUQUERQUE NM
87110-1389
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-9793
  • Fax: 505-884-8082
Mailing address:
  • Phone: 505-884-9793
  • Fax: 505-884-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1559
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: