Provider Demographics
NPI:1205057718
Name:MILLEA, DAVID J (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:MILLEA
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:PO BOX 4464
Mailing Address - Street 2:2746 NO 63RD ST
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104
Mailing Address - Country:US
Mailing Address - Phone:402-553-1042
Mailing Address - Fax:402-553-1042
Practice Address - Street 1:2746 NO 63RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104
Practice Address - Country:US
Practice Address - Phone:402-553-1042
Practice Address - Fax:402-553-1042
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4582OtherSTATE LICENSE NO
NE10025374100Medicaid
NE4582OtherSTATE LICENSE NO