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NPI Code Detail

MEDICARE: MRS. VINESSA JAYNE MILLS LT, R.D.H., B.S.

MEDICARE: MRS. VINESSA JAYNE MILLS LT, R.D.H., B.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
1124Q00000XDental Hygienist2764OK

General Provider Information

NPI Number : 1811960180
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. VINESSA JAYNE MILLS LT, R.D.H., B.S.
Provider Business Mailing Address
First Line : 902 E LINCOLN RD
Second Line :
City : IDABEL
State : OK
Zip : 74745-7337
Country : US
Telephone Number : 580-286-2600
Fax Number : 580-286-1172
Provider Business Practice Location Address
First Line : 902 E LINCOLN RD
Second Line :
City : IDABEL
State : OK
Zip : 74745-7337
Country : US
Telephone Number : 580-286-2600
Fax Number : 580-286-1172
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2006
Last Update Date : 07/08/2007

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