Provider Demographics
NPI:1891862843
Name:MILAN, JIMMY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:W
Last Name:MILAN
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 1:4337 BALL CAMP PK
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921
Mailing Address - Country:US
Mailing Address - Phone:865-546-7121
Mailing Address - Fax:865-522-5256
Practice Address - Street 1:4337 BALL CAMP PK
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921
Practice Address - Country:US
Practice Address - Phone:865-546-7121
Practice Address - Fax:865-522-5256
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist