Provider Demographics
NPI:1356414270
Name:MCMILLIN, JEFF (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:MCMILLIN
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 1:120 PHLOX CRK
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-4757
Mailing Address - Country:US
Mailing Address - Phone:423-968-1933
Mailing Address - Fax:
Practice Address - Street 1:1705 EDGEMON AVENUE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-968-1933
Practice Address - Fax:423-968-5015
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS37531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAM1093525OtherD.E.A.