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1121 W 2nd St Bloomington IN 47403-2160 | |
| (812) 339-1671 | |
| (812) 337-1231 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1121 W 2nd St, Bloomington, Indiana |
| Authorized Official Name and Position | Daniel J. Millikan (OWNER/DENTIST) |
| Authorized Official Contact | 8123391671 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1121 W 2nd St Bloomington IN 47403-2160 Ph: (812) 339-1671 | 1121 W 2nd St Bloomington IN 47403-2160 Ph: (812) 339-1671 |
| NPI Number | 1811405335 |
|---|---|
| Provider Enumeration Date | 01/18/2018 |
| Last Update Date | 01/18/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811405335 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12016033 (Indiana) | Primary |
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