Roderick E McMillen DDS a Dental Corp

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

18587 Issued in CA

Legal business name

RODERICK E MCMILLEN DDS A DENTAL CORP

Practice address

825 Sequoia Circle
Fort Bragg, CA 95347

Phone

(707) 964-0242

Fax

(707) 964-0244

NPI assigned

Sep 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Roderick E McMillen, DDSNPI 1457503310

Title

President of Small Corp

Phone

(707) 964-0242

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Roderick E. McMillen Jr., D.D.S.

  • Dentist
  • Fort Bragg, CA
  • NPI 1457503310
  NPD (past) Authorized official
• Jeff Bertheola, DDS

  • General Practice Dentistry
  • Fort Bragg, CA
  • NPI 1679194906
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215037684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 SEQUOIA CIRCLE",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "95347",
            "telephone_number": "707-964-0242",
            "fax_number": "707-964-0244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 SEQUOIA CIRCLE",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "95347",
            "telephone_number": "707-964-0242",
            "fax_number": "707-964-0244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RODERICK E MCMILLEN DDS A DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCMILLEN",
        "authorized_official_first_name": "RODERICK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT OF SMALL CORP",
        "authorized_official_telephone_number": "707-964-0242",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "18587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Richter, RDH
• Ries Chiropractic Associates Apc
• Micah David Ries, DC
• Christopher Robshaw, M.D.
• John Arthur Rochat, M.D.
• Victor Manuel Rodriguez
• Mary Rosenthal
• Glenn Alfred Rude, MFC
• Tina Nicolette Rueda
• Russell Perry MD, a Medical Corporation

• General Practice Dentistry in Fort Bragg, CA
• Providers in Fort Bragg, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.