Provider Demographics
NPI:1811148406
Name:MCMILLAN, KENNETH ARTHUR (DMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ARTHUR
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 1:2790 GARDENWOOD CT SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4784
Mailing Address - Country:US
Mailing Address - Phone:770-979-9986
Mailing Address - Fax:770-979-9986
Practice Address - Street 1:2790 GARDENWOOD CT SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-4784
Practice Address - Country:US
Practice Address - Phone:770-979-9986
Practice Address - Fax:770-979-9986
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8281122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA401OtherMEDICAL COLLEGE OF GEORGIA SCHOOL OF DENTISTRY