Basic Information
| Provider Information | |||||||||
| NPI: | 1730280918 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLS | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | CARLTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6950 NE CAMPUS WAY | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971245611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039522000 | ||||||||
| FaxNumber: | 5032553114 | ||||||||
| Practice Location | |||||||||
| Address1: | 13255 SE STARK ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972331548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032551901 | ||||||||
| FaxNumber: | 5032553114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 04/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D5838 | OR | Y | Dental Providers | Dentist | General Practice | 122300000X | DE 60121517 | WA | N | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 228965 | 01 | OR | OREGON HEALTH PLAN PROVID | OTHER |