Provider Demographics
NPI:1730280918
Name:MILLS, PHILIP CARLTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:CARLTON
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 1:6950 NE CAMPUS WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5611
Mailing Address - Country:US
Mailing Address - Phone:503-952-2000
Mailing Address - Fax:503-255-3114
Practice Address - Street 1:13255 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1548
Practice Address - Country:US
Practice Address - Phone:503-255-1901
Practice Address - Fax:503-255-3114
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD58381223G0001X
WADE 60121517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR228965OtherOREGON HEALTH PLAN PROVID