Provider Demographics
NPI:1689194748
Name:MILBURN DENTISTRY, LLC
Entity Type:Organization
Organization Name:MILBURN DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-249-1333
Mailing Address - Street 1:6009 FISH HAWK CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-5245
Mailing Address - Country:US
Mailing Address - Phone:864-367-6928
Mailing Address - Fax:
Practice Address - Street 1:803 2ND AVE N
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3016
Practice Address - Country:US
Practice Address - Phone:843-249-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty