MEDICARE: MILBURN DENTISTRY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4356	SC

General Provider Information

NPI Number	:	1689194748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILBURN DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	6009 FISH HAWK CT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-5245
Country	:	US
Telephone Number	:	864-367-6928
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 2ND AVE N
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3016
Country	:	US
Telephone Number	:	843-249-1333
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. CRAIG L MILBURN
Credential	:	DMD
Telephone Number	:	843-249-1333

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	06/20/2017

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