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General NPI Number Information
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NPI Number | 1457033268
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Entity Type | Organization
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Legal Business Name | VILLAGE DENTAL MILFORD LLC
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Dates
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Enumeration Date | 08/01/2023
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 1107 ALLEN DR STE B
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City | MILFORD
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State | OH
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Zip | 45150-8033
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Country | US
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Telephone | 720-822-3502
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Fax |
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Provider Business Mailing Address
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Address Line | 6598 WYNDWATCH DR
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City | CINCINNATI
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State | OH
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Zip | 45230-5266
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Country | US
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Telephone | 720-822-3502
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLYN MALENFANT
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Credential |
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Telephone | 303-968-7625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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