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General NPI Number Information
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NPI Number | 1356720106
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Entity Type | Organization
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Legal Business Name | KATHLEEN M MULLANEY DDS LLC
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 700 N FAIRFAX ST STE 230
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2040
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Country | US
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Telephone | 703-548-8584
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Fax | 703-548-0014
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Provider Business Mailing Address
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Address Line | 700 N FAIRFAX ST STE 230
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2040
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Country | US
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Telephone | 703-548-8584
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Fax | 703-548-0014
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHLEEN MATHESON MULLANEY
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Credential | DDS
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Telephone | 703-548-8584
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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 | 0401007018
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License Number State | VA
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