Provider Demographics
NPI:1942630298
Name:MCMILLAN, MICHAEL HAROLD (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HAROLD
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7167
Mailing Address - Country:US
Mailing Address - Phone:239-549-5590
Mailing Address - Fax:
Practice Address - Street 1:4215 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7167
Practice Address - Country:US
Practice Address - Phone:239-549-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-24
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist