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General NPI Number Information
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NPI Number | 1154176287
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Entity Type | Individual
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Provider Name | EDWARD MCMILLAN
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Gender | Male
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 224 WEST D. L. INGRAM AVE BLDG 1408
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City | CANNON AFB
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State | NM
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Zip | 88103-5014
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Country | US
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Telephone | 575-784-2778
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Fax |
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Provider Business Mailing Address
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Address Line | 77 NEALY AVE
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City | LANGLEY AFB
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State | VA
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Zip | 23665-2040
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | DGD.10823
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License Number State | SC
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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 | 10823
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License Number State | SC
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