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General NPI Number Information
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NPI Number | 1013375021
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Entity Type | Organization
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Legal Business Name | KEVIN A. MILTKO DDS
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 1550 SOUTH AVE W
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City | MISSOULA
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State | MT
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Zip | 59801-7806
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Country | US
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Telephone | 406-721-1550
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Fax | 406-721-1552
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Provider Business Mailing Address
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Address Line | 1550 SOUTH AVE W
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City | MISSOULA
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State | MT
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Zip | 59801-7806
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Country | US
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Telephone | 406-721-1550
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Fax | 406-721-1552
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN A. MILTKO
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Credential | DDS
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Telephone | 406-721-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1939
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License Number State | MT
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