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General NPI Number Information
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NPI Number | 1013495639
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Entity Type | Individual
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Provider Name | KENNETH ANDREW MILLARD DDS
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Gender | Male
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 3D DEN BN 3D MLG UNIT 38450
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City | FPO
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State | AP
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Zip | 96373-8450
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Country | US
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Telephone | 315-645-2390
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Fax |
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Provider Business Mailing Address
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Address Line | 34 W 1700 S
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City | OREM
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State | UT
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Zip | 84058-7470
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Country | US
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Telephone | 801-400-2857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 102947
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 121136879921
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License Number State | UT
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