Provider Demographics
NPI:1629005574
Name:DAVID D. MILLEN, D.M.D. PC
Entity Type:Organization
Organization Name:DAVID D. MILLEN, D.M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-732-0097
Mailing Address - Street 1:560 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401
Mailing Address - Country:US
Mailing Address - Phone:203-562-9700
Mailing Address - Fax:203-782-6285
Practice Address - Street 1:560 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401
Practice Address - Country:US
Practice Address - Phone:203-562-9700
Practice Address - Fax:203-782-6285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0041831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty