Provider Demographics
NPI:1821172594
Name:MILLAR, WAYNE RUSSELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:RUSSELL
Last Name:MILLAR
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 1:25 KANEOHE BAY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1711
Mailing Address - Country:US
Mailing Address - Phone:808-254-2124
Mailing Address - Fax:808-254-2464
Practice Address - Street 1:25 KANEOHE BAY DR STE 102
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1711
Practice Address - Country:US
Practice Address - Phone:808-254-2124
Practice Address - Fax:808-254-2464
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17901223G0001X
MD96811223G0001X
CA350021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice