Provider Demographics
NPI:1184356677
Name:MILLEY, BRIAN DANIEL (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DANIEL
Last Name:MILLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 CAUSEWAY DR STE 303
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28480-1984
Mailing Address - Country:US
Mailing Address - Phone:781-277-1470
Mailing Address - Fax:
Practice Address - Street 1:3572 LELAND TOWN CENTER DR STE 140
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-0680
Practice Address - Country:US
Practice Address - Phone:910-782-4735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12856122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist