Healthcare Provider Details

I. General information

NPI: 1417036583
Provider Name (Legal Business Name): CARL K MCMILLAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 E 50 S
AMERICAN FORK UT
84003-3837
US

IV. Provider business mailing address

355 E 50 S
AMERICAN FORK UT
84003-3837
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-0900
  • Fax: 801-756-7290
Mailing address:
  • Phone: 801-756-0900
  • Fax: 801-756-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number142879-9922
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number142879-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: