Provider Demographics
NPI:1356554430
Name:MILESTONE, MATTHEW IRA (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:IRA
Last Name:MILESTONE
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 1:27 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2722
Mailing Address - Country:US
Mailing Address - Phone:201-845-8411
Mailing Address - Fax:201-368-8355
Practice Address - Street 1:27 MADISON AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2722
Practice Address - Country:US
Practice Address - Phone:201-845-8411
Practice Address - Fax:201-368-8355
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ113231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics