Milan Manoj Irvin, D.M.D.
Individual provider Active NPI Dentist · Alta Loma, CA
NPI 1174871966 · NPPES record last updated Aug 27, 2012
Key facts
- NPI
- 1174871966
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 61782 (CA)
- Practice address
- 9330 Baseline Rd
Ste 108
Alta Loma, CA 91701-5827 - Phone
- (510) 387-5812
- NPI assigned
- Aug 27, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61782 | CA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61782 | CA | Yes |
Addresses
Primary practice location
9330 Baseline Rd
Ste 108
Alta Loma, CA 91701-5827
Mailing address
9330 Baseline Rd
Ste 108
Alta Loma, CA 91701-5827
Phone (510) 387-5812
Other providers in Alta Loma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.