Healthcare Provider Details

I. General information

NPI: 1497727747
Provider Name (Legal Business Name): SCOTT MILTENBERGER DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 GEORGIA ST NE STE C4
ALBUQUERQUE NM
87110-1389
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 NumberNM1559
License Number StateNM

VIII. Authorized Official

Name: LAUREL LYNN DEANDA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 505-884-9793