Healthcare Provider Details

I. General information

NPI: 1659337863
Provider Name (Legal Business Name): SATISH C. MULLICK B.D.S.;D.M.D.; M.S.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BERGEN ST
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

110 BERGEN ST
NEWARK NJ
07103-2495
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-2444
  • Fax: 973-972-2441
Mailing address:
  • Phone: 973-972-4557
  • Fax: 973-972-0370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: