Provider Demographics
NPI:1689793200
Name:MILNER, JAN ELLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:ELLEN
Last Name:MILNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 EDEN WAY N
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2751
Mailing Address - Country:US
Mailing Address - Phone:757-436-1200
Mailing Address - Fax:757-436-0534
Practice Address - Street 1:1113 EDEN WAY N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2751
Practice Address - Country:US
Practice Address - Phone:757-436-1200
Practice Address - Fax:757-436-0534
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010062391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice