Provider Demographics
NPI:1881687382
Name:MILLIGAN, TED R (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:R
Last Name:MILLIGAN
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8123 E HARRY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-4603
Mailing Address - Country:US
Mailing Address - Phone:316-686-3397
Mailing Address - Fax:316-682-7765
Practice Address - Street 1:8123 E HARRY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-4603
Practice Address - Country:US
Practice Address - Phone:316-686-3397
Practice Address - Fax:316-682-7765
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2008-05-21
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
KS52771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI736472OtherUNITED CONCORDIA /USAF
IA8636OtherBC/BS OF KS