Provider Demographics
NPI:1508399296
Name:MILLS, ANDREW JACKSON IV (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JACKSON
Last Name:MILLS
Suffix:IV
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 FRIST BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2057
Mailing Address - Country:US
Mailing Address - Phone:615-883-0067
Mailing Address - Fax:
Practice Address - Street 1:5651 FRIST BLVD STE 301
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2057
Practice Address - Country:US
Practice Address - Phone:615-883-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000106531223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty