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General NPI Number Information
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NPI Number | 1619538576
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Entity Type | Individual
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Provider Name | JACQUELYNN CRISTIN MILLS DDS
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Gender | Female
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Dates
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Enumeration Date | 06/21/2019
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Last Update Date | 06/21/2019
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Provider Practice Location Address
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Address Line | 6104 S 1ST ST STE 103
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City | AUSTIN
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State | TX
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Zip | 78745-4052
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Country | US
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Telephone | 512-222-9772
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 18894
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City | AUSTIN
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State | TX
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Zip | 78760-8894
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Country | US
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Telephone | 484-336-3155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 35345
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License Number State | TX
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