Provider Demographics
NPI:1457503310
Name:MCMILLEN, RODERICK E JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:E
Last Name:MCMILLEN
Suffix:JR
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 1:825 SEQUOIA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5422
Mailing Address - Country:US
Mailing Address - Phone:707-964-0242
Mailing Address - Fax:707-964-0244
Practice Address - Street 1:825 SEQUOIA CIRCLE
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5422
Practice Address - Country:US
Practice Address - Phone:707-964-0242
Practice Address - Fax:707-964-0244
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist