Healthcare Provider Details

I. General information

NPI: 1346842309
Provider Name (Legal Business Name): STEPHANIE L MULLINS DDS MS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 NE RALPH POWELL RD STE C
LEES SUMMIT MO
64064-2330
US

IV. Provider business mailing address

3470 NE RALPH POWELL RD STE C
LEES SUMMIT MO
64064-2330
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-9800
  • Fax:
Mailing address:
  • Phone: 816-524-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: FAITH GASKINS
Title or Position: CREDENTIALING DIRECTOR
Credential:
Phone: 972-869-3789