Healthcare Provider Details

I. General information

NPI: 1093743411
Provider Name (Legal Business Name): DONALD EUGENE MILLS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 OAKWELL FARMS PKWY SUITE 240
SAN ANTONIO TX
78218-1777
US

IV. Provider business mailing address

1919 OAKWELL FARMS PKWY SUITE 240
SAN ANTONIO TX
78218-1777
US

V. Phone/Fax

Practice location:
  • Phone: 210-824-6787
  • Fax: 210-824-2652
Mailing address:
  • Phone: 210-824-6787
  • Fax: 210-824-2652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7857
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: