Provider Demographics
NPI:1265603963
Name:MILLIGAN, TARA W (DDS)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:W
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:MILLIGAN
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:313 MOOTY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-1809
Mailing Address - Country:US
Mailing Address - Phone:706-837-0123
Mailing Address - Fax:706-884-2649
Practice Address - Street 1:313 MOOTY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-1809
Practice Address - Country:US
Practice Address - Phone:706-837-0123
Practice Address - Fax:706-884-2649
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0114551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice