Provider Demographics
NPI:1285152348
Name:MILROY ENDODONTICS
Entity type:Organization
Organization Name:MILROY ENDODONTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:MILROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-327-9268
Mailing Address - Street 1:1325 DRY CREEK DR STE 302
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-7751
Mailing Address - Country:US
Mailing Address - Phone:303-651-0202
Mailing Address - Fax:720-652-9430
Practice Address - Street 1:1325 DRY CREEK DR STE 302
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-7751
Practice Address - Country:US
Practice Address - Phone:303-651-0202
Practice Address - Fax:720-652-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002020981223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty