Healthcare Provider Details

I. General information

NPI: 1902556475
Provider Name (Legal Business Name): DAWN MARIE MULLENS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 03/26/2022
Certification Date: 03/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 E EMORY RD
KNOXVILLE TN
37938-4431
US

IV. Provider business mailing address

144 CARDWELL DR
TAZEWELL TN
37879-4550
US

V. Phone/Fax

Practice location:
  • Phone: 865-947-9890
  • Fax:
Mailing address:
  • Phone: 142-385-1128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH0000005290
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: