MEDICARE: DR. DOUGLAS J MILLS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2652	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000728091	OTHER	MS BCBS INS
2	728091	OTHER	UNITED CONCORDIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629161930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS J MILLS D.D.S.

Provider Business Mailing Address
First Line	:	1301 ELIZABETH PIKE
Second Line	:	P.O. BOX 729
City	:	ELIZABETH
State	:	WV
Zip	:	26143
Country	:	US
Telephone Number	:	304-275-4289
Fax Number	:	304-275-3900

Provider Business Practice Location Address
First Line	:	1301 ELIZABETH PIKE
Second Line	:
City	:	ELIZABETH
State	:	WV
Zip	:	26143
Country	:	US
Telephone Number	:	304-275-4289
Fax Number	:	304-275-3900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	10/14/2008

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