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General NPI Number Information
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NPI Number | 1497043863
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Entity Type | Individual
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Provider Name | STEPHANIE LAUREN MULLINS DDS
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Gender | Female
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 08/09/2011
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Provider Practice Location Address
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Address Line | 3470 NE RALPH POWELL RD STE C
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City | LEES SUMMIT
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State | MO
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Zip | 64064-2336
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Country | US
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Telephone | 816-719-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 3470 NE RALPH POWELL RD STE C
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City | LEES SUMMIT
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State | MO
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Zip | 64064-2336
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Country | US
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Telephone | 816-719-3200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2002011111
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2002011111
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2002011111
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License Number State | MO
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