Healthcare Provider Details

I. General information

NPI: 1326589946
Provider Name (Legal Business Name): MARINA MILGROM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 KIMBALL ST STE 202
BROOKLYN NY
11234-5159
US

IV. Provider business mailing address

3068 SUSAN RD
BELLMORE NY
11710-5224
US

V. Phone/Fax

Practice location:
  • Phone: 718-253-0888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number060619
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: