Healthcare Provider Details

I. General information

NPI: 1053462622
Provider Name (Legal Business Name): SYDNEY ANN MULLINS DMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 LYNDON LANE STE 211
LOUISVILLE KY
40222
US

IV. Provider business mailing address

1313 LYNDON LANE STE 211
LOUISVILLE KY
40222
US

V. Phone/Fax

Practice location:
  • Phone: 502-412-1166
  • Fax: 502-339-0433
Mailing address:
  • Phone: 502-412-1166
  • Fax: 502-339-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. SYDNEY ANN MULLINS
Title or Position: OWNER
Credential: DMD
Phone: 502-412-1166