Provider Demographics
NPI:1942676143
Name:TOM T. MILLIKEN, DDS LLC
Entity Type:Organization
Organization Name:TOM T. MILLIKEN, DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:T
Authorized Official - Last Name:MILLIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-757-3648
Mailing Address - Street 1:1810 EE WALLACE BLVD N STE 2
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-2253
Mailing Address - Country:US
Mailing Address - Phone:318-757-9370
Mailing Address - Fax:
Practice Address - Street 1:1810 EE WALLACE BLVD N STE 2
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2253
Practice Address - Country:US
Practice Address - Phone:318-757-9370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5976122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty