Provider Demographics
NPI:1033426473
Name:NEW MILLENNIUM DENTALCARE INC
Entity Type:Organization
Organization Name:NEW MILLENNIUM DENTALCARE INC
Other - Org Name:NATIONWIDE DENTAL PLAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/DENTAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GILLICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:732-286-0336
Mailing Address - Street 1:PO BOX 11155
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32524-1155
Mailing Address - Country:US
Mailing Address - Phone:732-286-0336
Mailing Address - Fax:732-286-0454
Practice Address - Street 1:1805 N 6TH AVE
Practice Address - Street 2:ROOM 12
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-4518
Practice Address - Country:US
Practice Address - Phone:732-286-0336
Practice Address - Fax:732-286-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization