Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 004183 | CT |
NPI | 1083689640 |
---|---|
Provider Name | Dr. David D Millen |
First Address | Ansonia, CT 06401 |
Second Address | Ansonia, CT 06401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 21/06/2016 |