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General NPI Number Information
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NPI Number | 1356634208
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Entity Type | Organization
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Legal Business Name | MARK A. MILANI D.D.S. PC
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 4777 E STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61108-2273
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Country | US
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Telephone | 815-399-3092
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Fax | 815-399-3092
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Provider Business Mailing Address
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Address Line | 4777 E STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61108-2273
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Country | US
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Telephone | 815-399-3092
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Fax | 815-399-3092
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Authorized Official
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Title or Position | CEO
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Name | DR. MARK ALAN MILANI
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Credential | DDS
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Telephone | 815-399-3092
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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 | 019020264
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License Number State | IL
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