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General NPI Number Information
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NPI Number | 1558572289
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Entity Type | Organization
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Legal Business Name | C KNOX MCMILLAN DDS, MS, PA ,
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 2310 MYRON DR
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City | RALEIGH
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State | NC
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Zip | 27607-3358
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Country | US
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Telephone | 919-781-6217
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Fax | 919-781-6213
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Provider Business Mailing Address
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Address Line | 2310 MYRON DR
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City | RALEIGH
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State | NC
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Zip | 27607-3358
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Country | US
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Telephone | 919-781-6217
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Fax | 919-781-6213
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. C KNOX MCMILLAN
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Credential | D.D.S. M.S. P.A.
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Telephone | 919-781-6217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 3581
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License Number State | NC
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