Provider Demographics
NPI:1437218369
Name:MCMILLAN, JASON EDDIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:EDDIE
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 SE 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-8303
Mailing Address - Country:US
Mailing Address - Phone:503-772-1022
Mailing Address - Fax:
Practice Address - Street 1:7727 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-6360
Practice Address - Country:US
Practice Address - Phone:503-254-1323
Practice Address - Fax:503-254-6626
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD77981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice