Provider Demographics
NPI:1598483471
Name:MCMILLON, NATHAN ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ALEXANDER
Last Name:MCMILLON
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 1:8412 173RD ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6280
Mailing Address - Country:US
Mailing Address - Phone:952-250-4635
Mailing Address - Fax:
Practice Address - Street 1:7631 145TH ST W
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-5530
Practice Address - Country:US
Practice Address - Phone:952-432-8696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND147861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice