Provider Demographics
NPI:1811405335
Name:MILLIKAN DENTISTRY PC
Entity Type:Organization
Organization Name:MILLIKAN DENTISTRY PC
Other - Org Name:MILLIKAN SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLIKAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-339-1671
Mailing Address - Street 1:1121 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2160
Mailing Address - Country:US
Mailing Address - Phone:812-339-1671
Mailing Address - Fax:812-337-1231
Practice Address - Street 1:1121 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2160
Practice Address - Country:US
Practice Address - Phone:812-339-1671
Practice Address - Fax:812-337-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12016033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty