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General NPI Number Information
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NPI Number | 1851361901
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Entity Type | Individual
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Provider Name | LESLIE C. MILLAR D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | BRANCH HEALTH CLINIC BLD. 3911 EAST AVE. SUITE B
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City | PENSACOLA NAVAL AIR STATION
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State | FL
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Zip | 32508-5141
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Country | US
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Telephone | 850-452-8970
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Fax | 850-452-8978
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Provider Business Mailing Address
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Address Line | 5501 WILLARD NORRIS RD
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City | MILTON
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State | FL
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Zip | 32570-8817
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Country | US
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Telephone | 850-981-3447
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Fax | 850-452-8978
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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 | A00328
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License Number State | AK
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