Provider Demographics
NPI:1326333659
Name:MCMILLAN, KARL (DDS)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:MCMILLAN
Suffix:
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 1:133 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:NY
Mailing Address - Zip Code:10027
Mailing Address - Country:US
Mailing Address - Phone:212-923-2525
Mailing Address - Fax:
Practice Address - Street 1:133 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4802
Practice Address - Country:US
Practice Address - Phone:212-923-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 055235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist