Provider Demographics
NPI:1598951071
Name:HUMPLIK, MILAN MARIA (DMD)
Entity Type:Individual
Prefix:MR
First Name:MILAN
Middle Name:MARIA
Last Name:HUMPLIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3037
Mailing Address - Country:US
Mailing Address - Phone:781-575-6770
Mailing Address - Fax:203-413-4355
Practice Address - Street 1:713 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3037
Practice Address - Country:US
Practice Address - Phone:781-575-6770
Practice Address - Fax:203-413-4355
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA178371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice