Provider Demographics
NPI:1942343140
Name:MILLS, JERRY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:J
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:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-0030
Mailing Address - Country:US
Mailing Address - Phone:270-247-2747
Mailing Address - Fax:270-247-2720
Practice Address - Street 1:212 N 7TH ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1820
Practice Address - Country:US
Practice Address - Phone:270-247-2747
Practice Address - Fax:270-247-2720
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice