MEDICARE: MRS. DIANA LEE MILLS R.D.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	799	OK

General Provider Information

NPI Number	:	1205817665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA LEE MILLS R.D.H.

Provider Business Mailing Address
First Line	:	2901 DEL CASA CIR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-6912
Country	:	US
Telephone Number	:	405-733-4650
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 ARNOLD ST
Second Line	:
City	:	TINKER AFB
State	:	OK
Zip	:	73145-8105
Country	:	US
Telephone Number	:	405-736-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/08/2007

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