1033426473 NPI number — NEW MILLENNIUM DENTALCARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033426473 NPI number — NEW MILLENNIUM DENTALCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW MILLENNIUM DENTALCARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NATIONWIDE DENTAL PLAN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033426473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11155
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32524-1155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-286-0336
Provider Business Mailing Address Fax Number:
732-286-0454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1805 N 6TH AVE
Provider Second Line Business Practice Location Address:
ROOM 12
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32503-4518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-286-0336
Provider Business Practice Location Address Fax Number:
732-286-0454
Provider Enumeration Date:
09/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GILLICH
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
CEO/DENTAL DIRECTOR
Authorized Official Telephone Number:
732-286-0336

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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