Provider Demographics
NPI:1881647162
Name:MILLES, MAANO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAANO
Middle Name:
Last Name:MILLES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BERGEN ST
Mailing Address - Street 2:DEPT. OMFS UMDNJ/NJDS
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2495
Mailing Address - Country:US
Mailing Address - Phone:973-972-4238
Mailing Address - Fax:973-972-7322
Practice Address - Street 1:110 BERGEN ST
Practice Address - Street 2:DEPT. OMFS UMDNJ/NJDS
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07101-1709
Practice Address - Country:US
Practice Address - Phone:973-972-4238
Practice Address - Fax:973-972-7322
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ91651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1994808Medicaid
NJ169954CY8Medicare ID - Type UnspecifiedPROVIDER
NJU49230Medicare UPIN