Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN 21913 | FL |
NPI | 1003266719 |
---|---|
Provider Name | Alicia Margarita Millan-Morales |
First Address | Largo, FL 33771-2438 |
Second Address | Largo, FL 33771-2438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2016 |
Last Update Date | 07/07/2019 |