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General NPI Number Information
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NPI Number | 1013585504
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Entity Type | Individual
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Provider Name | DOMINIC LUKE MILANO DDS
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Gender | Male
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Dates
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Enumeration Date | 06/11/2021
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | 210 OLD HIGHWAY 61 S
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City | HINCKLEY
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State | MN
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Zip | 55037-8375
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Country | US
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Telephone | 132-038-4611
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Fax |
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Provider Business Mailing Address
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Address Line | 90 MALCOLM AVE SE APT 2
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City | MINNEAPOLIS
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State | MN
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Zip | 55414-3545
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Country | US
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Telephone | 269-487-7331
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | D14566
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License Number State | MN
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