Provider Demographics
NPI:1932335965
Name:MILLIKEN, TOM TERRY III (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:TERRY
Last Name:MILLIKEN
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 ADVOCATE ROW
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373
Mailing Address - Country:US
Mailing Address - Phone:318-757-3648
Mailing Address - Fax:318-757-9370
Practice Address - Street 1:202 ADVOCATE ROW
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373
Practice Address - Country:US
Practice Address - Phone:318-757-3648
Practice Address - Fax:318-757-9370
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice