Provider Demographics
NPI:1689832958
Name:MCMILLAN, MATTHEW WILLIAM (BDENT (DDS))
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:BDENT (DDS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:NEAH BAY
Mailing Address - State:WA
Mailing Address - Zip Code:98357-0410
Mailing Address - Country:US
Mailing Address - Phone:360-640-3913
Mailing Address - Fax:
Practice Address - Street 1:250 FORT ST
Practice Address - Street 2:
Practice Address - City:NEAH BAY
Practice Address - State:WA
Practice Address - Zip Code:98357
Practice Address - Country:US
Practice Address - Phone:360-645-2459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 600876831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice