Provider Demographics
NPI:1245300920
Name:MILLIREN, MICHAEL R (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:MILLIREN
Suffix:
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 1:925 HIGHWAY 55
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-3734
Mailing Address - Country:US
Mailing Address - Phone:651-437-7844
Mailing Address - Fax:651-437-3454
Practice Address - Street 1:925 HIGHWAY 55
Practice Address - Street 2:SUITE 102
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-3734
Practice Address - Country:US
Practice Address - Phone:651-437-7844
Practice Address - Fax:651-437-3454
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist