Provider Demographics
NPI:1063433209
Name:MCMILLEN ORTHODONTICS LTD
Entity type:Organization
Organization Name:MCMILLEN ORTHODONTICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCMILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:401-331-7171
Mailing Address - Street 1:1226 HARTFORD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-7100
Mailing Address - Country:US
Mailing Address - Phone:401-331-7171
Mailing Address - Fax:401-331-2755
Practice Address - Street 1:1226 HARTFORD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7100
Practice Address - Country:US
Practice Address - Phone:401-331-7171
Practice Address - Fax:401-331-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN01491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty