Provider Demographics
NPI:1578994745
Name:MILLA, EMERSON (DMD)
Entity Type:Individual
Prefix:
First Name:EMERSON
Middle Name:
Last Name:MILLA
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 1:1021 SIBLEY ST APT C
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3535
Mailing Address - Country:US
Mailing Address - Phone:510-396-5365
Mailing Address - Fax:
Practice Address - Street 1:2205 FRANCISCO DR STE 150
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-3943
Practice Address - Country:US
Practice Address - Phone:916-934-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist