Provider Demographics
NPI:1821371055
Name:MILLS, CAROL L (DDS)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:L
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 1:3201 PIONEERS BLVD
Mailing Address - Street 2:STE 308
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502
Mailing Address - Country:US
Mailing Address - Phone:402-441-4400
Mailing Address - Fax:401-441-4403
Practice Address - Street 1:3201 PIONEERS BLVD
Practice Address - Street 2:STE 308
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502
Practice Address - Country:US
Practice Address - Phone:402-441-4400
Practice Address - Fax:402-441-4403
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist