Provider Demographics
NPI:1831384965
Name:MCMILLAN, SAMUEL ALLAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ALLAN
Last Name:MCMILLAN
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 1:305 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NE
Mailing Address - Zip Code:68620-1224
Mailing Address - Country:US
Mailing Address - Phone:402-395-2211
Mailing Address - Fax:
Practice Address - Street 1:305 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NE
Practice Address - Zip Code:68620-1224
Practice Address - Country:US
Practice Address - Phone:402-395-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE42601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice