Provider Demographics
NPI:1699939165
Name:MCMILLAN, PAT L (DDS)
Entity type:Individual
Prefix:DR
First Name:PAT
Middle Name:L
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 W CRAFT
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454
Mailing Address - Country:US
Mailing Address - Phone:618-546-1100
Mailing Address - Fax:
Practice Address - Street 1:708 W CRAFT
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454
Practice Address - Country:US
Practice Address - Phone:618-546-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist