Provider Demographics
NPI:1073689774
Name:GARY D MILTON DDS
Entity Type:Organization
Organization Name:GARY D MILTON DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:MILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:928-774-0131
Mailing Address - Street 1:710 N BEAVER ST
Mailing Address - Street 2:BLDG 2 1
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3144
Mailing Address - Country:US
Mailing Address - Phone:928-774-0131
Mailing Address - Fax:928-226-0560
Practice Address - Street 1:710 N BEAVER ST
Practice Address - Street 2:BLDG 2 1
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3144
Practice Address - Country:US
Practice Address - Phone:928-774-0131
Practice Address - Fax:928-226-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty