Provider Demographics
NPI:1154745867
Name:MILFORD DENTAL SPECIALIST, P.C.
Entity type:Organization
Organization Name:MILFORD DENTAL SPECIALIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:VILLEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-876-9965
Mailing Address - Street 1:209 BOSTON POST RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3161
Mailing Address - Country:US
Mailing Address - Phone:203-876-9965
Mailing Address - Fax:203-876-9972
Practice Address - Street 1:209 BOSTON POST RD
Practice Address - Street 2:SUITE 312
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3161
Practice Address - Country:US
Practice Address - Phone:203-876-9965
Practice Address - Fax:203-876-9972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008668122300000X
1223G0001X, 1223P0221X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty