Provider Demographics
NPI:1043571318
Name:FAMILY DENTAL OF BRENTWOOD PC
Entity Type:Organization
Organization Name:FAMILY DENTAL OF BRENTWOOD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MILHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-665-2323
Mailing Address - Street 1:769 COMMACK RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-7407
Mailing Address - Country:US
Mailing Address - Phone:631-665-2323
Mailing Address - Fax:631-647-7003
Practice Address - Street 1:769 COMMACK RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-7407
Practice Address - Country:US
Practice Address - Phone:631-665-2323
Practice Address - Fax:631-647-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034623-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty