Provider Demographics
NPI:1154572410
Name:MCMILLEN, RICHARD K (DN)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:K
Last Name:MCMILLEN
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 S RAY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3832
Mailing Address - Country:US
Mailing Address - Phone:509-535-7434
Mailing Address - Fax:509-536-4744
Practice Address - Street 1:1723 S RAY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-3832
Practice Address - Country:US
Practice Address - Phone:509-535-7434
Practice Address - Fax:509-536-4744
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60035947122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist