Provider Demographics
NPI:1023131885
Name:SAMADDAR, MILAGROSA B (DDS)
Entity type:Individual
Prefix:
First Name:MILAGROSA
Middle Name:B
Last Name:SAMADDAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MILAGROSA
Other - Middle Name:
Other - Last Name:BANARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HIGHWAY 98 & NAVAJO ROUTE 16
Mailing Address - Street 2:HC70 BOX 9
Mailing Address - City:TONALEA
Mailing Address - State:AZ
Mailing Address - Zip Code:86044
Mailing Address - Country:US
Mailing Address - Phone:928-672-3041
Mailing Address - Fax:928-672-3005
Practice Address - Street 1:INSCRIPTION HOUSE HEALTH CENTER
Practice Address - Street 2:HIGHWAY 98& NAVAJO RT 16
Practice Address - City:TONALEA
Practice Address - State:AZ
Practice Address - Zip Code:86044
Practice Address - Country:US
Practice Address - Phone:928-672-3041
Practice Address - Fax:928-672-3005
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007895A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice