Provider Demographics
NPI:1831645316
Name:MILLOT & MILLOT DENTAL CORP
Entity Type:Organization
Organization Name:MILLOT & MILLOT DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLOT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-948-2361
Mailing Address - Street 1:9330 BASELINE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5827
Mailing Address - Country:US
Mailing Address - Phone:909-948-2361
Mailing Address - Fax:909-948-2368
Practice Address - Street 1:9330 BASELINE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-5827
Practice Address - Country:US
Practice Address - Phone:909-948-2361
Practice Address - Fax:909-948-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60188261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental