Provider Demographics
NPI:1497354559
Name:MILLS, WES (DMD)
Entity Type:Individual
Prefix:DR
First Name:WES
Middle Name:
Last Name:MILLS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 PORTLAND RD STE 5
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6651
Mailing Address - Country:US
Mailing Address - Phone:207-985-3500
Mailing Address - Fax:
Practice Address - Street 1:58 PORTLAND RD STE 5
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6651
Practice Address - Country:US
Practice Address - Phone:207-985-3500
Practice Address - Fax:207-985-5874
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist