Active NPI
Jack Olen Mills, D.D.S.
- Oral and Maxillofacial Pathology Dentistry
- Livermore, CA
National Provider Identifier
1184780660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Pathology Dentistry
- License
- 16954
- Practice address
- 60 Fenton St
Suite 7
Livermore, CA 94550-4148 - Phone
- (925) 443-4211
- Fax
- (925) 443-4716
- NPI assigned
- Dec 28, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Oral and Maxillofacial Pathology Dentistry | 1223P0106X | 16954 | CA | Primary |
Addresses
Primary practice location
60 Fenton St
Suite 7
Livermore, CA 94550-4148
Mailing address
60 Fenton St
Suite 7
Livermore, CA 94550-4148
Phone (925) 443-4211
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 6, 2016 through May 6, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16954 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1184780660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 FENTON ST",
"address_2": "SUITE 7",
"city": "LIVERMORE",
"state": "CA",
"postal_code": "945504148",
"telephone_number": "925-443-4211",
"fax_number": "925-443-4716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 FENTON ST",
"address_2": "SUITE 7",
"city": "LIVERMORE",
"state": "CA",
"postal_code": "945504148",
"telephone_number": "925-443-4211",
"fax_number": "925-443-4716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLS",
"first_name": "JACK",
"middle_name": "OLEN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0106X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Pathology",
"state": "CA",
"license": "16954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livermore, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.