Provider Demographics
NPI:1730142118
Name:MILANA, MATTHEW J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:MILANA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 E INDIAN SCHOOL RD
Mailing Address - Street 2:STE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5337
Mailing Address - Country:US
Mailing Address - Phone:602-957-2170
Mailing Address - Fax:602-957-2263
Practice Address - Street 1:4214 E INDIAN SCHOOL RD
Practice Address - Street 2:STE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5337
Practice Address - Country:US
Practice Address - Phone:602-957-2170
Practice Address - Fax:602-957-2263
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice