Healthcare Provider Details

I. General information

NPI: 1497033013
Provider Name (Legal Business Name): ANDREW PATRICK MULKA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2011
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E MAYNE ST
BLUE GRASS IA
52726-9718
US

IV. Provider business mailing address

133 E MAYNE ST
BLUE GRASS IA
52726-9718
US

V. Phone/Fax

Practice location:
  • Phone: 563-381-4830
  • Fax:
Mailing address:
  • Phone: 563-381-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number08842
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.028796
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: