Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DENO1479 | RI |
NPI | 1003896697 |
---|---|
Provider Name | Dr. Fredrick H Mcmillen |
First Address | Johnston, RI 02919 |
Second Address | Johnston, RI 02919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1479 | DELTA DENTAL (01) | RI |
89292 | BLUE CROSS (01) | RI |
FM00711 | (05) | RI |