Provider Demographics
NPI:1457547754
Name:MILLERLUNG DENTAL GROUP
Entity Type:Organization
Organization Name:MILLERLUNG DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:FANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-399-8130
Mailing Address - Street 1:288 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-6846
Mailing Address - Country:US
Mailing Address - Phone:508-399-8130
Mailing Address - Fax:508-761-5280
Practice Address - Street 1:288 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-6846
Practice Address - Country:US
Practice Address - Phone:508-399-8130
Practice Address - Fax:508-761-5280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16607/179351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty