Provider Demographics
NPI:1417273855
Name:MCMILLENS DENTURE CLINIC
Entity Type:Organization
Organization Name:MCMILLENS DENTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KERN
Authorized Official - Last Name:MCMILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:509-368-9537
Mailing Address - Street 1:1723 S RAY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3832
Mailing Address - Country:US
Mailing Address - Phone:509-368-9537
Mailing Address - Fax:509-536-4744
Practice Address - Street 1:1723 S RAY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-3832
Practice Address - Country:US
Practice Address - Phone:509-368-9537
Practice Address - Fax:509-536-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60035947122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty