Provider Demographics
NPI:1750657540
Name:MILESTONE DENTAL, PLLC
Entity Type:Organization
Organization Name:MILESTONE DENTAL, PLLC
Other - Org Name:MILESTONE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHALIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:817-635-6453
Mailing Address - Street 1:5005 S COOPER ST STE 173
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-8600
Mailing Address - Country:US
Mailing Address - Phone:817-635-6453
Mailing Address - Fax:817-635-6457
Practice Address - Street 1:5005 S COOPER ST STE 173
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-8600
Practice Address - Country:US
Practice Address - Phone:817-635-6453
Practice Address - Fax:817-635-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty