Healthcare Provider Details

I. General information

NPI: 1811960180
Provider Name (Legal Business Name): VINESSA JAYNE MILLS LT, R.D.H., B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E LINCOLN RD
IDABEL OK
74745-7337
US

IV. Provider business mailing address

902 E LINCOLN RD
IDABEL OK
74745-7337
US

V. Phone/Fax

Practice location:
  • Phone: 580-286-2600
  • Fax: 580-286-1172
Mailing address:
  • Phone: 580-286-2600
  • Fax: 580-286-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2764
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: