MEDICARE: SYDNEY ANN MULLINS DMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4500353000	OTHER	KY	EPSDT

General Provider Information

NPI Number	:	1053462622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYDNEY ANN MULLINS DMA

Provider Business Mailing Address
First Line	:	1313 LYNDON LANE
Second Line	:	STE 211
City	:	LOUISVILLE
State	:	KY
Zip	:	40222
Country	:	US
Telephone Number	:	502-412-1166
Fax Number	:	502-339-0433

Provider Business Practice Location Address
First Line	:	1313 LYNDON LANE
Second Line	:	STE 211
City	:	LOUISVILLE
State	:	KY
Zip	:	40222
Country	:	US
Telephone Number	:	502-412-1166
Fax Number	:	502-339-0433

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SYDNEY ANN MULLINS
Credential	:	DMD
Telephone Number	:	502-412-1166

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	08/22/2020

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Directions to “SYDNEY ANN MULLINS DMA ” Practice Location

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