Healthcare Provider Details

I. General information

NPI: 1821060096
Provider Name (Legal Business Name): JEFFREY B. MCMILLAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGHWAY 51 N
BATESVILLE MS
38606-2311
US

IV. Provider business mailing address

9360 W FLAMINGO RD #110-308
LAS VEGAS NV
89147-6426
US

V. Phone/Fax

Practice location:
  • Phone: 702-505-1900
  • Fax: 662-578-7207
Mailing address:
  • Phone: 702-505-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberOR-509-16
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: