Provider Demographics
NPI:1811268675
Name:MILLIGAN, MICHAEL T (DMD, PA)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:MILLIGAN
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 15TH ST E STE 110
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-4844
Mailing Address - Country:US
Mailing Address - Phone:941-756-7020
Mailing Address - Fax:
Practice Address - Street 1:5108 15TH STREET EAST
Practice Address - Street 2:SUITE 110
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4844
Practice Address - Country:US
Practice Address - Phone:941-756-7020
Practice Address - Fax:941-755-2761
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN120261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice