Provider Demographics
NPI:1922019132
Name:MILLETT, KERRI LOU (DDS)
Entity Type:Individual
Prefix:DR
First Name:KERRI
Middle Name:LOU
Last Name:MILLETT
Suffix:
Gender:F
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:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-0760
Mailing Address - Country:US
Mailing Address - Phone:269-651-3377
Mailing Address - Fax:269-659-3428
Practice Address - Street 1:1820 EAST CHICAGO RD
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-0760
Practice Address - Country:US
Practice Address - Phone:269-651-3377
Practice Address - Fax:269-659-3428
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010142211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice