NPI: 1215037684 · FORT BRAGG, CA 95347 · General Practice Dentistry · NPI assigned 09/25/2006
| Authorized Official | MCMILLEN, RODERICK (PRESIDENT OF SMALL CORP) |
| NPI Enumeration Date | 09/25/2006 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 13 | $390.00 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | 13 | 13 | $390.00 |