MEDICARE: DR. JERRY J MILLS DDS

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	1223G0001X	General Practice Dentistry	3518	KY

General Provider Information

NPI Number	:	1942343140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY J MILLS DDS

Provider Business Mailing Address
First Line	:	PO BOX 429
Second Line	:
City	:	MAYFIELD
State	:	KY
Zip	:	42066-0030
Country	:	US
Telephone Number	:	270-247-2747
Fax Number	:	270-247-2720

Provider Business Practice Location Address
First Line	:	212 N 7TH ST
Second Line	:
City	:	MAYFIELD
State	:	KY
Zip	:	42066-1820
Country	:	US
Telephone Number	:	270-247-2747
Fax Number	:	270-247-2720

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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