Provider Demographics
NPI:1750580254
Name:MILNER, MATTHEW L (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:L
Last Name:MILNER
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 1:4500 I 55 N STE 266
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5932
Mailing Address - Country:US
Mailing Address - Phone:601-932-8920
Mailing Address - Fax:
Practice Address - Street 1:4500 I 55 N STE 266
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5932
Practice Address - Country:US
Practice Address - Phone:601-932-8920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3446-08122300000X
MSPROS-444-111223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist