Active NPI
Dolores Jean Millard, RDH
- Dental Hygienist
- Zia Pueblo, NM
National Provider Identifier
1174848543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 808
- Practice address
- 155B Capitol Square Drive
Zia Pueblo, NM 87053-6013 - Phone
- (505) 867-5258
- NPI assigned
- Mar 29, 2010
- Last updated
- Mar 29, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 808 | NM | Primary |
Addresses
Primary practice location
155B Capitol Square Drive
Zia Pueblo, NM 87053-6013
Mailing address
104 Sarah LN NW
Albuquerque, NM 87114-1007
Phone (505) 922-1040
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11115 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 808 | NM | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269820800000",
"number": "1174848543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 SARAH LN NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871141007",
"telephone_number": "505-922-1040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155B CAPITOL SQUARE DRIVE",
"city": "ZIA PUEBLO",
"state": "NM",
"postal_code": "870536013",
"telephone_number": "505-867-5258"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLARD",
"first_name": "DOLORES",
"middle_name": "JEAN",
"name_prefix": "Ms.",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-03-29",
"last_updated": "2010-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "NM",
"license": "808",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "11115",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Zia Pueblo, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.