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General NPI Number Information
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NPI Number | 1558180083
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Entity Type | Organization
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Legal Business Name | AFTERGLOW ANESTHESIA PLLC
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 3400 INTERSTATE HIGHWAY 30
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City | MESQUITE
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State | TX
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Zip | 75150-2601
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Country | US
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Telephone | 817-516-8811
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Fax | 817-516-8444
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Provider Business Mailing Address
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Address Line | 3737 STANFORD AVE
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City | DALLAS
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State | TX
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Zip | 75225-7204
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Country | US
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Telephone | 817-516-8811
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Fax | 817-516-8444
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Authorized Official
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Title or Position | OWNER
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Name | MIKE MULLENS
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Credential | MD
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Telephone | 214-864-5812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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