Provider Demographics
NPI:1215028717
Name:MILEM, HOMER DARRELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOMER
Middle Name:DARRELL
Last Name:MILEM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:H.
Other - Middle Name:DARRELL
Other - Last Name:MILEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:305 N STURMER ST
Mailing Address - Street 2:
Mailing Address - City:BELINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26250-9216
Mailing Address - Country:US
Mailing Address - Phone:304-823-2100
Mailing Address - Fax:
Practice Address - Street 1:305 N STURMER ST
Practice Address - Street 2:
Practice Address - City:BELINGTON
Practice Address - State:WV
Practice Address - Zip Code:26250-9216
Practice Address - Country:US
Practice Address - Phone:304-823-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0136986000Medicaid