Basic Information
Provider Information
NPI: 1740560093
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLNER
FirstName: EMILY
MiddleName: ALICE
NamePrefix: MISS
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 4337
Address2:  
City: FRISCO
State: CO
PostalCode: 804434337
CountryCode: US
TelephoneNumber: 9706684053
FaxNumber: 9706686699
Practice Location
Address1: 360 PEAK ONE DRIVE
Address2:  
City: FRISCO
State: CO
PostalCode: 80443
CountryCode: US
TelephoneNumber: 9706684053
FaxNumber: 9706686699
Other Information
ProviderEnumerationDate: 08/18/2011
LastUpdateDate: 08/18/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
124Q00000X906324COY Dental ProvidersDental Hygienist 

No ID Information.


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