Provider Demographics
NPI:1487848065
Name:MILLS, MARK J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:MILLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:3355 N ACADEMY BLVD
Mailing Address - Street 2:BOX 633
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5103
Mailing Address - Country:US
Mailing Address - Phone:719-641-6587
Mailing Address - Fax:719-683-5974
Practice Address - Street 1:10 RUPERT ST
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1042
Practice Address - Country:US
Practice Address - Phone:719-852-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics