Provider Demographics
NPI:1700971744
Name:MILLETT, BRIAN S (DMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:MILLETT
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 1:19 SEWARD RD
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1176
Mailing Address - Country:US
Mailing Address - Phone:781-438-2179
Mailing Address - Fax:
Practice Address - Street 1:184 PLEASANT VALLEY ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5817
Practice Address - Country:US
Practice Address - Phone:978-685-3191
Practice Address - Fax:978-687-5901
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist