Provider Demographics
NPI:1235259615
Name:MILLETT, JEFFREY EARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EARL
Last Name:MILLETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 E CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1921
Mailing Address - Country:US
Mailing Address - Phone:269-651-6700
Mailing Address - Fax:269-659-8604
Practice Address - Street 1:905 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1921
Practice Address - Country:US
Practice Address - Phone:269-651-6700
Practice Address - Fax:269-659-8604
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI092551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice