Provider Demographics
NPI:1528119575
Name:MILAVEC, THOMAS ANTHONY (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:MILAVEC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE DENTAL HEALTH CLINIC
Mailing Address - Street 2:107 S MARKET ST STE 2
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-4824
Mailing Address - Country:US
Mailing Address - Phone:570-752-8753
Mailing Address - Fax:570-759-6372
Practice Address - Street 1:THE DENTAL HEALTH CLINIC
Practice Address - Street 2:107 S MARKET ST STE 2
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-4824
Practice Address - Country:US
Practice Address - Phone:570-752-8753
Practice Address - Fax:570-759-6372
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029631L1223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016529800002Medicaid