Provider Demographics
NPI:1831408004
Name:MILLS, SUZANNA ASHBY (DMD)
Entity type:Individual
Prefix:
First Name:SUZANNA
Middle Name:ASHBY
Last Name:MILLS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 GATEWAY DR APT AA
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2562
Mailing Address - Country:US
Mailing Address - Phone:270-316-2074
Mailing Address - Fax:
Practice Address - Street 1:412 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1711
Practice Address - Country:US
Practice Address - Phone:270-452-2553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY88871223G0001X
IN12012077A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100143940Medicaid