Provider Demographics
NPI:1275015950
Name:MCMILLAN FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:MCMILLAN FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-888-2026
Mailing Address - Street 1:1720 W MCMILLAN RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6892
Mailing Address - Country:US
Mailing Address - Phone:208-216-6110
Mailing Address - Fax:208-639-1357
Practice Address - Street 1:1720 W MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6892
Practice Address - Country:US
Practice Address - Phone:208-216-6110
Practice Address - Fax:208-639-1357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental