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General NPI Number Information
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NPI Number | 1811405335
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Entity Type | Organization
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Legal Business Name | MILLIKAN DENTISTRY PC
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 01/18/2018
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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 | 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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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MR. DANIEL J. MILLIKAN
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Credential | DDS
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Telephone | 812-339-1671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12016033
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License Number State | IN
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