Provider Demographics
NPI:1023296613
Name:MILLS, LINISHA (DDS)
Entity type:Individual
Prefix:
First Name:LINISHA
Middle Name:
Last Name:MILLS
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 1:204 RICH RD
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1612
Mailing Address - Country:US
Mailing Address - Phone:312-933-6908
Mailing Address - Fax:
Practice Address - Street 1:2555 LINCOLN HWY
Practice Address - Street 2:SUITE 111
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1936
Practice Address - Country:US
Practice Address - Phone:708-679-0668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD143011223G0001X
DCDEN10006881223G0001X
IL0190282431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice