Provider Demographics
NPI:1376630129
Name:MILLS, RYAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:MILLS
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 1:8028 S EMERSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237
Mailing Address - Country:US
Mailing Address - Phone:317-883-3300
Mailing Address - Fax:317-889-3348
Practice Address - Street 1:8028 S EMERSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237
Practice Address - Country:US
Practice Address - Phone:317-883-3300
Practice Address - Fax:317-889-3348
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120104161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1368963OtherUNITED CONCORDIA