MEDICARE: DR. ALAN R MULLY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN14014	MA

General Provider Information

NPI Number	:	1972687416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN R MULLY DMD

Provider Business Mailing Address
First Line	:	149 CAVE HILL RD
Second Line	:
City	:	LEVERETT
State	:	MA
Zip	:	01054-9728
Country	:	US
Telephone Number	:	413-367-2817
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 CAVE HILL RD
Second Line	:
City	:	LEVERETT
State	:	MA
Zip	:	01054-9728
Country	:	US
Telephone Number	:	413-367-2817
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	11/13/2009

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