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General NPI Number Information
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NPI Number | 1033426473
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Entity Type | Organization
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Legal Business Name | NEW MILLENNIUM DENTALCARE INC
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Dates
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Enumeration Date | 09/07/2010
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 1805 N 6TH AVE ROOM 12
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City | PENSACOLA
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State | FL
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Zip | 32503-4518
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Country | US
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Telephone | 732-286-0336
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Fax | 732-286-0454
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Provider Business Mailing Address
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Address Line | PO BOX 11155
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City | PENSACOLA
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State | FL
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Zip | 32524-1155
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Country | US
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Telephone | 732-286-0336
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Fax | 732-286-0454
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Authorized Official
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Title or Position | CEO/DENTAL DIRECTOR
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Name | MR. PAUL JOHN GILLICH JR.
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Credential |
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Telephone | 732-286-0336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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