Provider Demographics
NPI:1831208974
Name:MILLS, DAVID JEREMY (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JEREMY
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 1:1221 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-6209
Mailing Address - Country:US
Mailing Address - Phone:361-729-7710
Mailing Address - Fax:361-790-9560
Practice Address - Street 1:1221 W MARKET ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-6209
Practice Address - Country:US
Practice Address - Phone:361-729-7710
Practice Address - Fax:361-790-9560
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice