=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427910041
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL B. MULLANY D.M.D. P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2025
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 PLEASANT ST
-----------------------------------------------------
City | GREAT BARRINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01230-1325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-528-0884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 PLEASANT ST
-----------------------------------------------------
City | GREAT BARRINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01230-1325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-528-0884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL BURKE MULLANY
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 413-429-1133
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------