Provider Demographics
NPI:1851361901
Name:MILLAR, LESLIE C (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:C
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 1:5501 WILLARD NORRIS RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-8817
Mailing Address - Country:US
Mailing Address - Phone:850-981-3447
Mailing Address - Fax:850-452-8978
Practice Address - Street 1:BRANCH HEALTH CLINIC BLD. 3911 EAST AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:PENSACOLA NAVAL AIR STATION
Practice Address - State:FL
Practice Address - Zip Code:32508-5141
Practice Address - Country:US
Practice Address - Phone:850-452-8970
Practice Address - Fax:850-452-8978
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKA003281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice