Provider Demographics
NPI:1417972811
Name:MILOS, 3JAMIE LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:3JAMIE
Middle Name:LYNN
Last Name:MILOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-2228
Mailing Address - Country:US
Mailing Address - Phone:815-962-1400
Mailing Address - Fax:815-962-1218
Practice Address - Street 1:1334 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2228
Practice Address - Country:US
Practice Address - Phone:815-962-1400
Practice Address - Fax:815-962-1218
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice