Provider Demographics
NPI:1497923981
Name:JANICEK, MILOS R (DMD)
Entity Type:Individual
Prefix:DR
First Name:MILOS
Middle Name:R
Last Name:JANICEK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:70 HOWARD STREET
Mailing Address - Street 2:PROFESSIONAL ENDODONTICS
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320
Mailing Address - Country:US
Mailing Address - Phone:860-447-2572
Mailing Address - Fax:860-447-2638
Practice Address - Street 1:70 HOWARD STREET
Practice Address - Street 2:PROFESSIONAL ENDODONTICS
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-447-2572
Practice Address - Fax:860-447-2638
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIDEN030001223E0200X
CT0098881223E0200X
MA217301223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics