Provider Demographics
NPI:1316931132
Name:MILANI, MASOUD (DMD)
Entity type:Individual
Prefix:DR
First Name:MASOUD
Middle Name:
Last Name:MILANI
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 GLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23665-1940
Mailing Address - Country:US
Mailing Address - Phone:757-764-7525
Mailing Address - Fax:
Practice Address - Street 1:138 GLOVER AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23665-1940
Practice Address - Country:US
Practice Address - Phone:757-764-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 146261223G0001X
FLDN14626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist