Provider Demographics
NPI:1225152671
Name:MCMILLAN, ALEX IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:MCMILLAN
Suffix:IV
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 BURKE CENTRE PKWY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3750
Mailing Address - Country:US
Mailing Address - Phone:703-503-9490
Mailing Address - Fax:703-503-3083
Practice Address - Street 1:6035 BURKE CENTRE PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3750
Practice Address - Country:US
Practice Address - Phone:703-503-9490
Practice Address - Fax:703-503-3083
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA6453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist