Provider Demographics
NPI:1487792800
Name:SCOTT G MILO DMD PA
Entity type:Organization
Organization Name:SCOTT G MILO DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:G
Authorized Official - Last Name:MILO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:321-453-2450
Mailing Address - Street 1:2405 NORTH COURTENAY PARKWAY
Mailing Address - Street 2:#105
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4050
Mailing Address - Country:US
Mailing Address - Phone:321-453-2450
Mailing Address - Fax:321-453-2450
Practice Address - Street 1:2405 NORTH COURTENAY PARKWAY
Practice Address - Street 2:#105
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4050
Practice Address - Country:US
Practice Address - Phone:321-453-2450
Practice Address - Fax:321-453-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN111271223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty