Individual
MS. DOLORES JEAN MILLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
155B CAPITOL SQUARE DRIVE, ZIA PUEBLO, NM 87053-6013
(505) 867-5258
Mailing address
104 SARAH LN NW, ALBUQUERQUE, NM 87114-1007
(505) 922-1040
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
808
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11115
—
NM
Enumeration date
03/29/2010
Last updated
03/29/2010
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