Provider Demographics
NPI:1558572289
Name:C KNOX MCMILLAN DDS, MS, PA ,
Entity Type:Organization
Organization Name:C KNOX MCMILLAN DDS, MS, PA ,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:KNOX
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS PA
Authorized Official - Phone:919-781-6217
Mailing Address - Street 1:2310 MYRON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3358
Mailing Address - Country:US
Mailing Address - Phone:919-781-6217
Mailing Address - Fax:919-781-6213
Practice Address - Street 1:2310 MYRON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3358
Practice Address - Country:US
Practice Address - Phone:919-781-6217
Practice Address - Fax:919-781-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35811223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995843Medicaid