Healthcare Provider Details

I. General information

NPI: 1467386490
Provider Name (Legal Business Name): ALYSSA ANN MULROY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4680 S WASHINGTON ST STE A
GRAND FORKS ND
58201-5456
US

IV. Provider business mailing address

4680 S WASHINGTON ST STE A
GRAND FORKS ND
58201-5456
US

V. Phone/Fax

Practice location:
  • Phone: 701-772-3544
  • Fax:
Mailing address:
  • Phone: 701-772-3544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2592
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: