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General NPI Number Information
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NPI Number | 1417085184
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Entity Type | Organization
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Legal Business Name | DANA W MULLIS DMD PC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1003 PLAZA AVE
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City | EASTMAN
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State | GA
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Zip | 31023
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Country | US
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Telephone | 478-374-1127
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Fax | 478-374-3588
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Provider Business Mailing Address
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Address Line | PO BOX 4098
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City | EASTMAN
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State | GA
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Zip | 31023-4098
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Country | US
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Telephone | 478-374-1127
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Fax | 478-374-3588
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Authorized Official
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Title or Position | CEO DMD
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Name | DR. DANA W MULLIS
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Credential |
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Telephone | 478-374-1127
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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 | 011878
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License Number State | GA
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