Provider Demographics
NPI:1407338510
Name:MILFORD FAMILY DENTAL PLLC
Entity type:Organization
Organization Name:MILFORD FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIAIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-291-2773
Mailing Address - Street 1:1 MILITIA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4704
Mailing Address - Country:US
Mailing Address - Phone:617-291-2773
Mailing Address - Fax:
Practice Address - Street 1:219 E MAIN ST STE 100A
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2828
Practice Address - Country:US
Practice Address - Phone:508-473-2393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental