Healthcare Provider Details

I. General information

NPI: 1275361966
Provider Name (Legal Business Name): DALLIN MILNE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 RIO BRAVO BLVD SW
ALBUQUERQUE NM
87105-6057
US

IV. Provider business mailing address

134 LAS MEDANALES CT NE
RIO RANCHO NM
87124-4186
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-9382
  • Fax:
Mailing address:
  • Phone: 435-229-7936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDB-2024-0245
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: