Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 21285 | MA |
NPI | 1265442321 |
---|---|
Provider Name | Mark J Milano |
First Address | Marion, MA 02738-0005 |
Second Address | N Dartmouth, MA 02747-3733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 08/07/2007 |