Provider Demographics
NPI:1790799765
Name:MILAK, NEELU (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEELU
Middle Name:
Last Name:MILAK
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 1:200 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2907
Mailing Address - Country:US
Mailing Address - Phone:410-939-3343
Mailing Address - Fax:
Practice Address - Street 1:111 BATA BLVD # D
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1431
Practice Address - Country:US
Practice Address - Phone:410-939-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521913101OtherTAX ID