Provider Demographics
NPI:1942348891
Name:MILLIGAN, LARIS WAYNE (DMD, MS)
Entity Type:Individual
Prefix:
First Name:LARIS
Middle Name:WAYNE
Last Name:MILLIGAN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 SHIPYARD BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8070
Mailing Address - Country:US
Mailing Address - Phone:910-799-5000
Mailing Address - Fax:910-799-2005
Practice Address - Street 1:2250 SHIPYARD BLVD STE 6
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8070
Practice Address - Country:US
Practice Address - Phone:910-799-5000
Practice Address - Fax:910-799-2005
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice