Provider Demographics
NPI:1639395155
Name:MILMAN, SIMON (DMD)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:MILMAN
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 1:2288 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4454
Mailing Address - Country:US
Mailing Address - Phone:609-695-6773
Mailing Address - Fax:609-695-2375
Practice Address - Street 1:2288 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4454
Practice Address - Country:US
Practice Address - Phone:609-695-6773
Practice Address - Fax:609-695-2375
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI13072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist