Basic Information
| Provider Information | |||||||||
| NPI: | 1730846296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLS | ||||||||
| FirstName: | SHAROLYNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RDH | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 36014 WRATTEN DRIVE | ||||||||
| Address2: | |||||||||
| City: | FORT HOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542867502 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | BILLY JOHNSON DENTAL CLINIC | ||||||||
| Address2: | 36014 WRATTEN DRIVE | ||||||||
| City: | FORT HOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542867502 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2021 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 22796 | CA | Y | Dental Providers | Dental Hygienist |
No ID Information.