Provider Demographics
NPI:1487012753
Name:MILAM-MORRISON, JADAH NOHEA (DH)
Entity Type:Individual
Prefix:
First Name:JADAH
Middle Name:NOHEA
Last Name:MILAM-MORRISON
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19336 W JOMAX RD
Mailing Address - Street 2:
Mailing Address - City:WITTMANN
Mailing Address - State:AZ
Mailing Address - Zip Code:85361-9743
Mailing Address - Country:US
Mailing Address - Phone:602-279-5262
Mailing Address - Fax:
Practice Address - Street 1:4041 N CENTRAL AVE
Practice Address - Street 2:BLDG. C
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3330
Practice Address - Country:US
Practice Address - Phone:602-279-5262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH008074124Q00000X
WADH00006154124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist