Provider Demographics
NPI:1598090383
Name:WAYNE R. MILLAR DDS INC
Entity type:Organization
Organization Name:WAYNE R. MILLAR DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:MILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-254-2124
Mailing Address - Street 1:25 KANEOHE BAY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1727
Mailing Address - Country:US
Mailing Address - Phone:808-254-2124
Mailing Address - Fax:808-254-2464
Practice Address - Street 1:25 KANEOHE BAY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1727
Practice Address - Country:US
Practice Address - Phone:808-254-2124
Practice Address - Fax:808-254-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty