Provider Demographics
NPI:1902809726
Name:MILAN DENTAL ASSOCIATES, D.D.S., P.C.
Entity Type:Organization
Organization Name:MILAN DENTAL ASSOCIATES, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-439-1543
Mailing Address - Street 1:519 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-9559
Mailing Address - Country:US
Mailing Address - Phone:734-439-1543
Mailing Address - Fax:734-439-0553
Practice Address - Street 1:519 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-9559
Practice Address - Country:US
Practice Address - Phone:734-439-1543
Practice Address - Fax:734-439-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4050468Medicaid
MI110788OtherPRUDENTIAL DMO ID
MI4135430Medicaid
MI2602947Medicaid