Provider Demographics
NPI:1417178161
Name:MILLS, SHAUNA MARIE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:MARIE
Last Name:MILLS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1938
Mailing Address - Street 2:110 N CAMP
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652
Mailing Address - Country:US
Mailing Address - Phone:662-534-5826
Mailing Address - Fax:662-534-9965
Practice Address - Street 1:110 N CAMP
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652
Practice Address - Country:US
Practice Address - Phone:662-534-5826
Practice Address - Fax:662-534-9965
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist