Provider Demographics
NPI:1376044859
Name:MILESTONE DENTAL OF NORTHLAKE PLLC
Entity Type:Organization
Organization Name:MILESTONE DENTAL OF NORTHLAKE PLLC
Other - Org Name:IDEAL DENTAL OF NORTHLAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-331-8079
Mailing Address - Street 1:PO BOX 840925
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5000 STATE HIGHWAY 114 STE 130
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76262-2076
Practice Address - Country:US
Practice Address - Phone:940-208-0130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty