Provider Demographics
NPI:1073341319
Name:MILUTINOVIC, ROLAN (DDS)
Entity type:Individual
Prefix:
First Name:ROLAN
Middle Name:
Last Name:MILUTINOVIC
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 1:901 E RIVER PKWY
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3105
Mailing Address - Country:US
Mailing Address - Phone:773-886-4905
Mailing Address - Fax:
Practice Address - Street 1:150 3RD ST NW
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:MN
Practice Address - Zip Code:56097-1021
Practice Address - Country:US
Practice Address - Phone:507-553-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND15179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist