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General NPI Number Information
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NPI Number | 1528136207
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Entity Type | Individual
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Provider Name | DANIEL J MILLIKAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1121 W 2ND ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2160
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Country | US
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Telephone | 812-339-1671
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Fax | 812-337-1231
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Provider Business Mailing Address
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Address Line | 314 W 4TH ST APT 108
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City | BLOOMINGTON
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State | IN
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Zip | 47404-5169
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Country | US
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Telephone |
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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 | 12010633A
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License Number State | IN
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