Provider Demographics
NPI:1659700094
Name:BRIAN S. MILLETT DMD PC
Entity Type:Organization
Organization Name:BRIAN S. MILLETT DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-685-3191
Mailing Address - Street 1:184 PLEASANT VALLEY ST
Mailing Address - Street 2:SUITE 2 202
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5817
Mailing Address - Country:US
Mailing Address - Phone:978-685-3191
Mailing Address - Fax:978-687-5901
Practice Address - Street 1:184 PLEASANT VALLEY ST
Practice Address - Street 2:SUITE 2 202
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5817
Practice Address - Country:US
Practice Address - Phone:978-685-3191
Practice Address - Fax:978-687-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty