Provider Demographics
NPI:1568895688
Name:MILLS, JERREL A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JERREL
Middle Name:A
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 1:1209 N RETAIL CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-9626
Mailing Address - Country:US
Mailing Address - Phone:843-843-4060
Mailing Address - Fax:
Practice Address - Street 1:1209 N RETAIL CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-9626
Practice Address - Country:US
Practice Address - Phone:843-843-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.8292 GD122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist