Healthcare Provider Details

I. General information

NPI: 1790483832
Provider Name (Legal Business Name): JOSEPH MULLEN DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S WESTLAKE BLVD STE 235
WESTLAKE VILLAGE CA
91361-6202
US

IV. Provider business mailing address

1240 S WESTLAKE BLVD STE 235
WESTLAKE VILLAGE CA
91361-6202
US

V. Phone/Fax

Practice location:
  • Phone: 805-496-9778
  • Fax:
Mailing address:
  • Phone: 805-496-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number105893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: