Healthcare Provider Details

I. General information

NPI: 1932198199
Provider Name (Legal Business Name): SYDNEY ANN MULLINS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 LYNDON LN SUITE 211
LOUISVILLE KY
40222-7351
US

IV. Provider business mailing address

1313 LYNDON LN SUITE 211
LOUISVILLE KY
40222-7351
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 Number7323
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: