Provider Demographics
NPI:1679697353
Name:MILAN, JOSE EDUARDO (DDS)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:EDUARDO
Last Name:MILAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 6736 LOIZA STATION
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00914
Mailing Address - Country:US
Mailing Address - Phone:787-723-8447
Mailing Address - Fax:787-723-8447
Practice Address - Street 1:ASHFORD MEDICAL CENTER SUITE 108A
Practice Address - Street 2:WASHINGTON STREET NUM 29
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-723-8447
Practice Address - Fax:787-723-8447
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice