Healthcare Provider Details

I. General information

NPI: 1306252184
Provider Name (Legal Business Name): ADAM M MILMONT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 TALON DR
CASPER WY
82604-3279
US

IV. Provider business mailing address

3090 TALON DR
CASPER WY
82604-3279
US

V. Phone/Fax

Practice location:
  • Phone: 307-237-1801
  • Fax: 307-237-3686
Mailing address:
  • Phone: 307-237-1801
  • Fax: 307-237-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1379
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: