Active NPI
Jerrel A Mills, D.M.D.
- Dentist
- Myrtle Beach, SC
National Provider Identifier
1568895688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DGD.8292 GD
- Practice address
- 1209 N Retail CT
Myrtle Beach, SC 29577-9626 - Phone
- (843) 843-4060
- NPI assigned
- Aug 12, 2013
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DGD.8292 GD | SC | Primary |
Addresses
Primary practice location
1209 N Retail CT
Myrtle Beach, SC 29577-9626
Mailing address
1209 N Retail CT
Myrtle Beach, SC 29577-9626
Phone (843) 843-4060
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 |
|---|---|---|---|
| DGD.8292 GD | SC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384387200000",
"number": "1568895688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1209 N RETAIL CT",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295779626",
"telephone_number": "843-843-4060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1209 N RETAIL CT",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295779626",
"telephone_number": "843-843-4060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLS",
"first_name": "JERREL",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-12",
"last_updated": "2013-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "DGD.8292 GD",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.