Provider Demographics
NPI:1275641979
Name:MCMILLAN, MILLICENT LEIGH (DDS)
Entity Type:Individual
Prefix:
First Name:MILLICENT
Middle Name:LEIGH
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MILLICENT
Other - Middle Name:LEIGH
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:247 BILTMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4107
Mailing Address - Country:US
Mailing Address - Phone:828-350-1076
Mailing Address - Fax:
Practice Address - Street 1:247 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4107
Practice Address - Country:US
Practice Address - Phone:828-350-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-902P5Medicaid
902P5OtherBLUE CROSS BLUE SHIELD NC