Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D06038 | AZ |
NPI | 1043586704 |
---|---|
Provider Name | James Millard |
First Address | Scottsdale, AZ 85262-5681 |
Second Address | Scottsdale, AZ 85262-5681 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2012 |
Last Update Date | 28/03/2012 |