Provider Demographics
NPI:1760686984
Name:MILLIREN FAMILY DENTISTRY
Entity type:Organization
Organization Name:MILLIREN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MILLIREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-437-7844
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124241223G0001X
MN98461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty