Healthcare Provider Details

I. General information

NPI: 1417030388
Provider Name (Legal Business Name): MARC E MULHOLLAND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 WASHINGTON AVE STE 914
BAY CITY MI
48708
US

IV. Provider business mailing address

916 WASHINGTON AVE STE 914
BAY CITY MI
48708
US

V. Phone/Fax

Practice location:
  • Phone: 989-892-9341
  • Fax: 989-892-7961
Mailing address:
  • Phone: 989-892-9341
  • Fax: 989-892-7961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number010010
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: