Provider Demographics
NPI:1306603691
Name:MILLS FAMILY DENTISTRY PA
Entity type:Organization
Organization Name:MILLS FAMILY DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STURDEVANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-298-4230
Mailing Address - Street 1:206 WALKER AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56567-4004
Mailing Address - Country:US
Mailing Address - Phone:218-385-3130
Mailing Address - Fax:
Practice Address - Street 1:206 WALKER AVE N
Practice Address - Street 2:
Practice Address - City:NEW YORK MILLS
Practice Address - State:MN
Practice Address - Zip Code:56567-4004
Practice Address - Country:US
Practice Address - Phone:218-385-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental