Provider Demographics
NPI:1679061980
Name:MILDER, MEGAN JENNING (DMD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JENNING
Last Name:MILDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 TULIK DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1134
Mailing Address - Country:US
Mailing Address - Phone:858-353-1096
Mailing Address - Fax:
Practice Address - Street 1:4341 TUDOR CENTRE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5904
Practice Address - Country:US
Practice Address - Phone:907-729-2000
Practice Address - Fax:907-729-5178
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1074761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery