Provider Demographics
NPI:1649287350
Name:MILLS, BRIAN CHARLES (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHARLES
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 1:525 SOUTH DR
Mailing Address - Street 2:#109
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4213
Mailing Address - Country:US
Mailing Address - Phone:650-961-6914
Mailing Address - Fax:650-961-6917
Practice Address - Street 1:525 SOUTH DR
Practice Address - Street 2:#109
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4213
Practice Address - Country:US
Practice Address - Phone:650-961-6914
Practice Address - Fax:650-961-6917
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist