Healthcare Provider Details

I. General information

NPI: 1336363878
Provider Name (Legal Business Name): KEITH ALLEN MILHOAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CHARLES ST
SISTERSVILLE WV
26175-1202
US

IV. Provider business mailing address

3103 9TH AVE
VIENNA WV
26105-2423
US

V. Phone/Fax

Practice location:
  • Phone: 304-447-2004
  • Fax: 304-447-2005
Mailing address:
  • Phone: 304-615-6441
  • Fax: 304-447-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3407
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: