Provider Demographics
NPI:1982992343
Name:MILLET, JEFFREY CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHRISTOPHER
Last Name:MILLET
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:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-0066
Mailing Address - Country:US
Mailing Address - Phone:641-236-6169
Mailing Address - Fax:641-236-6041
Practice Address - Street 1:825 BROAD ST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2153
Practice Address - Country:US
Practice Address - Phone:641-236-6169
Practice Address - Fax:641-236-6041
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice