Provider Demographics
NPI:1134468788
Name:MATTHEW S. MILLINER, DMD, PLLC
Entity Type:Organization
Organization Name:MATTHEW S. MILLINER, DMD, PLLC
Other - Org Name:MAYFIELD ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MILLINER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:270-247-0751
Mailing Address - Street 1:822 PARIS RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2743
Mailing Address - Country:US
Mailing Address - Phone:270-247-0751
Mailing Address - Fax:270-247-0757
Practice Address - Street 1:822 PARIS RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2743
Practice Address - Country:US
Practice Address - Phone:270-247-0751
Practice Address - Fax:270-247-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY91231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100224360Medicaid