Provider Demographics
NPI:1215155569
Name:MILILLO, DAMIAN COSMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:COSMAS
Last Name:MILILLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:19018-1203
Mailing Address - Country:US
Mailing Address - Phone:484-461-2389
Mailing Address - Fax:
Practice Address - Street 1:321 N LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1017
Practice Address - Country:US
Practice Address - Phone:610-626-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0365251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice