Provider Demographics
NPI:1013585504
Name:MILANO, DOMINIC LUKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:LUKE
Last Name:MILANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MALCOLM AVE SE APT 2
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3545
Mailing Address - Country:US
Mailing Address - Phone:269-487-7331
Mailing Address - Fax:
Practice Address - Street 1:210 OLD HIGHWAY 61 S
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:MN
Practice Address - Zip Code:55037-8375
Practice Address - Country:US
Practice Address - Phone:132-038-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND145661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice