Provider Demographics
NPI:1013375021
Name:KEVIN A. MILTKO DDS
Entity Type:Organization
Organization Name:KEVIN A. MILTKO DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILTKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-721-1550
Mailing Address - Street 1:1550 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7806
Mailing Address - Country:US
Mailing Address - Phone:406-721-1550
Mailing Address - Fax:406-721-1552
Practice Address - Street 1:1550 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7806
Practice Address - Country:US
Practice Address - Phone:406-721-1550
Practice Address - Fax:406-721-1552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty