Provider Demographics
NPI:1457033268
Name:VILLAGE DENTAL MILFORD LLC
Entity Type:Organization
Organization Name:VILLAGE DENTAL MILFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALENFANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-968-7625
Mailing Address - Street 1:6598 WYNDWATCH DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-5266
Mailing Address - Country:US
Mailing Address - Phone:720-822-3502
Mailing Address - Fax:
Practice Address - Street 1:1107 ALLEN DR STE B
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-8033
Practice Address - Country:US
Practice Address - Phone:720-822-3502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental