Provider Demographics
NPI:1992047161
Name:MILLIKEN, DEBORAH P (DMD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:P
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W COLLEGE DR
Mailing Address - Street 2:BLDG T-1
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-9356
Mailing Address - Country:US
Mailing Address - Phone:863-784-7023
Mailing Address - Fax:863-784-7026
Practice Address - Street 1:600 W COLLEGE DR
Practice Address - Street 2:BLDG T-1
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9356
Practice Address - Country:US
Practice Address - Phone:863-784-7023
Practice Address - Fax:863-784-7026
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN104691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice