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General NPI Number Information
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NPI Number | 1629005574
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Entity Type | Organization
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Legal Business Name | DAVID D. MILLEN, D.M.D. PC
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 560 MAIN STREET
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City | ANSONIA
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State | CT
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Zip | 06401
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Country | US
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Telephone | 203-562-9700
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Fax | 203-782-6285
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Provider Business Mailing Address
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Address Line | 560 MAIN STREET
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City | ANSONIA
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State | CT
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Zip | 06401
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Country | US
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Telephone | 203-562-9700
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Fax | 203-782-6285
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID D MILLEN
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Credential | D.M.D
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Telephone | 203-732-0097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 004183
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License Number State | CT
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