Provider Demographics
NPI:1932831658
Name:MILLENNIUM DENTISTRY PLLC
Entity Type:Organization
Organization Name:MILLENNIUM DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADLAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-880-1093
Mailing Address - Street 1:16800 W 12 MILE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-6335
Mailing Address - Country:US
Mailing Address - Phone:248-352-4789
Mailing Address - Fax:248-352-4825
Practice Address - Street 1:16800 W 12 MILE RD STE 103
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-6335
Practice Address - Country:US
Practice Address - Phone:248-352-4789
Practice Address - Fax:248-352-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental