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General NPI Number Information
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NPI Number | 1134468788
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Entity Type | Organization
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Legal Business Name | MATTHEW S. MILLINER, DMD, PLLC
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Dates
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Enumeration Date | 02/01/2013
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 822 PARIS RD
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City | MAYFIELD
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State | KY
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Zip | 42066-2743
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Country | US
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Telephone | 270-247-0751
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Fax | 270-247-0757
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Provider Business Mailing Address
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Address Line | 822 PARIS RD
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City | MAYFIELD
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State | KY
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Zip | 42066-2743
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Country | US
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Telephone | 270-247-0751
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Fax | 270-247-0757
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Authorized Official
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Title or Position | OWNER, ORTHODONTIST
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Name | DR. MATTHEW SCOTT MILLINER
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Credential | DMD, MS
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Telephone | 270-247-0751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9123
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License Number State | KY
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