Provider Demographics
NPI:1487199667
Name:MILLENNIUM SMILES
Entity Type:Organization
Organization Name:MILLENNIUM SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DUNIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, FICOI
Authorized Official - Phone:972-987-4899
Mailing Address - Street 1:8979 FM 423
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:972-987-4899
Mailing Address - Fax:972-987-4915
Practice Address - Street 1:8979 FARM TO MARKET RD 423 SUITE 400
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:UM
Practice Address - Phone:972-987-4899
Practice Address - Fax:972-987-4915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28879261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1134566052OtherHEALTH CARE INSURANCE COMPANIES