Provider Demographics
NPI:1982627550
Name:MILAN, MITCHELL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:S
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 1:1044 SUFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-4623
Mailing Address - Country:US
Mailing Address - Phone:248-644-2136
Mailing Address - Fax:
Practice Address - Street 1:555 S OLD WOODWARD AVE
Practice Address - Street 2:SUITE 701
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6658
Practice Address - Country:US
Practice Address - Phone:248-644-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist