MEDICARE: MR. DAVID S MCMILLAN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	3171	ME

General Provider Information

NPI Number	:	1316960461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID S MCMILLAN D.M.D.

Provider Business Mailing Address
First Line	:	PO BOX 340
Second Line	:
City	:	RANGELEY
State	:	ME
Zip	:	04970-0340
Country	:	US
Telephone Number	:	207-864-3400
Fax Number	:	207-864-2383

Provider Business Practice Location Address
First Line	:	2252 MAIN STREET
Second Line	:
City	:	RANGELEY
State	:	ME
Zip	:	04970
Country	:	US
Telephone Number	:	207-864-3400
Fax Number	:	207-864-2383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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