Provider Demographics
NPI:1235506486
Name:MILOS DENTAL CARE
Entity Type:Organization
Organization Name:MILOS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-315-4200
Mailing Address - Street 1:129 PHELPS AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2453
Mailing Address - Country:US
Mailing Address - Phone:815-315-4200
Mailing Address - Fax:815-315-4282
Practice Address - Street 1:129 PHELPS AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2453
Practice Address - Country:US
Practice Address - Phone:815-315-4200
Practice Address - Fax:815-315-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021151122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty