Provider Demographics
NPI:1619538576
Name:MILLS, JACQUELYNN CRISTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYNN
Middle Name:CRISTIN
Last Name:MILLS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 18894
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78760-8894
Mailing Address - Country:US
Mailing Address - Phone:484-336-3155
Mailing Address - Fax:
Practice Address - Street 1:6104 S 1ST ST STE 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4052
Practice Address - Country:US
Practice Address - Phone:512-222-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice