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General NPI Number Information
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NPI Number | 1629161930
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Entity Type | Individual
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Provider Name | DOUGLAS J MILLS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 1301 ELIZABETH PIKE
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City | ELIZABETH
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State | WV
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Zip | 26143
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Country | US
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Telephone | 304-275-4289
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Fax | 304-275-3900
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Provider Business Mailing Address
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Address Line | 1301 ELIZABETH PIKE P.O. BOX 729
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City | ELIZABETH
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State | WV
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Zip | 26143
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Country | US
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Telephone | 304-275-4289
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Fax | 304-275-3900
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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 | 2652
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License Number State | WV
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