=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780303255
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MULHIM DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2022
-----------------------------------------------------
Last Update Date | 08/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1840 N OLIVE AVE STE 4
-----------------------------------------------------
City | TRULOCK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95382-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-668-3227
-----------------------------------------------------
Fax | 209-669-8123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1902 WARING RD
-----------------------------------------------------
City | TURLOCK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95382-9222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-669-8120
-----------------------------------------------------
Fax | 209-669-8123
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RAMSON A MULHIM
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 209-669-8120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------