Provider Demographics
NPI:1811564917
Name:MILRUD, ESTELLE MICHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ESTELLE
Middle Name:MICHELLE
Last Name:MILRUD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ESTELLE
Other - Middle Name:MICHELLE
Other - Last Name:YANKELEVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1902 CRENSHAW CIR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1243
Mailing Address - Country:US
Mailing Address - Phone:267-690-6656
Mailing Address - Fax:
Practice Address - Street 1:2964 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:JOHNSBURG
Practice Address - State:IL
Practice Address - Zip Code:60051-5409
Practice Address - Country:US
Practice Address - Phone:815-363-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty