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General NPI Number Information
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NPI Number | 1578744876
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Entity Type | Organization
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Legal Business Name | J M MULLEN DDS PA
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 901 N WINSTEAD AVE STE 120
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-8467
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Country | US
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Telephone | 252-443-7575
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Fax | 252-443-3960
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Provider Business Mailing Address
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Address Line | 901 N WINSTEAD AVE STE 120
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-8467
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Country | US
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Telephone | 252-443-7575
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Fax | 252-443-3960
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK M MULLEN
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Credential | DDS PA
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Telephone | 252-443-7575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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