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General NPI Number Information
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NPI Number | 1285771030
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Entity Type | Organization
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Legal Business Name | ALBERT F MCMULLEN III DDS FDC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 02/09/2009
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Provider Practice Location Address
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Address Line | 2005 FORSYTHE AVENUE
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City | MONROE
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State | LA
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Zip | 71201
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Country | US
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Telephone | 318-322-0432
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Fax | 318-322-4537
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Provider Business Mailing Address
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Address Line | 2005 FORSYTHE AVENUE
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City | MONROE
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State | LA
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Zip | 71201
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Country | US
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Telephone | 318-322-0432
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Fax | 318-322-4537
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALBERT F MCMULLEN III
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Credential | DDS
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Telephone | 318-322-0432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5171
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4293
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License Number State | LA
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