Provider Demographics
NPI:1124030119
Name:MCMILLAN, VICKI M (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:M
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MEADOW VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3495
Mailing Address - Country:US
Mailing Address - Phone:757-673-6263
Mailing Address - Fax:
Practice Address - Street 1:300 E LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-2603
Practice Address - Country:US
Practice Address - Phone:757-583-1889
Practice Address - Fax:757-588-1724
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010087281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice