MEDICARE: TODD W MULLIKIN, DDS, PC

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	DN008703	GA

General Provider Information

NPI Number	:	1083623292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TODD W MULLIKIN, DDS, PC

Provider Business Mailing Address
First Line	:	3733 CANTON RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-2663
Country	:	US
Telephone Number	:	770-926-9914
Fax Number	:	770-926-0306

Provider Business Practice Location Address
First Line	:	3733 CANTON RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-2663
Country	:	US
Telephone Number	:	770-926-9914
Fax Number	:	770-926-0306

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. TODD WILSON MULLIKIN
Credential	:	DDS
Telephone Number	:	770-926-9914

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	03/25/2013

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