Provider Demographics
NPI:1811617079
Name:MILESTONES PEDIATRIC DENTISTRY, PLLC
Entity type:Organization
Organization Name:MILESTONES PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSHAN
Authorized Official - Middle Name:VIJAY
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-250-9559
Mailing Address - Street 1:3370 LONG PRAIRIE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-3000
Mailing Address - Country:US
Mailing Address - Phone:352-250-9559
Mailing Address - Fax:469-830-8074
Practice Address - Street 1:3370 LONG PRAIRIE RD STE 400
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-3000
Practice Address - Country:US
Practice Address - Phone:352-250-9559
Practice Address - Fax:469-830-8074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1114333903Medicaid