Healthcare Provider Details

I. General information

NPI: 1740673797
Provider Name (Legal Business Name): EMILEE PEEPLES MILLING D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 CRANE RIDGE DR STE 2
JACKSON MS
39216-4944
US

IV. Provider business mailing address

8051 SORRENTO LN
NAPLES FL
34114-2616
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-8585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3887-16
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: