Individual
THEODORE R MILLGARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
270 E MAIN ST, DAYTON, WA 99328-1353
(509) 540-9756
Mailing address
PO BOX 223, DAYTON, WA 99328-0223
(509) 540-9756
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3392
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5182506
—
WA
Enumeration date
10/04/2006
Last updated
03/16/2009
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