Provider Demographics
NPI:1093887283
Name:MILLIGAN, DANIEL LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LYNN
Last Name:MILLIGAN
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 1:1404 EASTLAND DR
Mailing Address - Street 2:#102
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3532
Mailing Address - Country:US
Mailing Address - Phone:309-663-9421
Mailing Address - Fax:309-663-1854
Practice Address - Street 1:1404 EASTLAND DR
Practice Address - Street 2:#102
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3532
Practice Address - Country:US
Practice Address - Phone:309-663-9421
Practice Address - Fax:309-663-1854
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice