Provider Demographics
NPI:1790764421
Name:MILLS, KEVEN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVEN
Middle Name:R
Last Name:MILLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 HAVILAND DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6442
Mailing Address - Country:US
Mailing Address - Phone:916-791-8673
Mailing Address - Fax:916-791-7487
Practice Address - Street 1:6910 DOUGLAS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6276
Practice Address - Country:US
Practice Address - Phone:916-791-7227
Practice Address - Fax:916-791-7487
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 352061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice