MEDICARE: DR. JOHN ELVERAGE MULLINS JR. DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	018367	NJ

General Provider Information

NPI Number	:	1265506968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ELVERAGE MULLINS JR. DMD

Provider Business Mailing Address
First Line	:	PO BOX 839
Second Line	:
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-0839
Country	:	US
Telephone Number	:	908-490-0560
Fax Number	:	908-490-0562

Provider Business Practice Location Address
First Line	:	567 PARK AVE
Second Line	:	SUITE 104
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-1754
Country	:	US
Telephone Number	:	908-490-0560
Fax Number	:	908-490-0562

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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