Provider Demographics
NPI:1871950923
Name:MILESTONE FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:MILESTONE FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PERDOMO-WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-626-0092
Mailing Address - Street 1:2200 US HIGHWAY 98
Mailing Address - Street 2:SUITE 8
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4395
Mailing Address - Country:US
Mailing Address - Phone:251-626-0092
Mailing Address - Fax:251-626-0092
Practice Address - Street 1:2200 US HIGHWAY 98
Practice Address - Street 2:SUITE 8
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4395
Practice Address - Country:US
Practice Address - Phone:251-626-0092
Practice Address - Fax:251-626-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty