Provider Demographics
NPI:1497727747
Name:SCOTT MILTENBERGER DMD, PC
Entity Type:Organization
Organization Name:SCOTT MILTENBERGER DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-884-9793
Mailing Address - Street 1:3901 GEORGIA ST NE STE C4
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1389
Mailing Address - Country:US
Mailing Address - Phone:505-884-9793
Mailing Address - Fax:505-884-8082
Practice Address - Street 1:3901 GEORGIA ST NE STE C4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1389
Practice Address - Country:US
Practice Address - Phone:505-884-9793
Practice Address - Fax:505-884-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM1559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty