MEDICARE: DR. KATHLEEN V. MULLEN D.M.D.

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	1223P0221X	Pediatric Dentistry	DS025133L	PA

General Provider Information

NPI Number	:	1811160898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN V. MULLEN D.M.D.

Provider Business Mailing Address
First Line	:	118 DICKERSON RD
Second Line	:	SUITE D
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2538
Country	:	US
Telephone Number	:	215-699-0650
Fax Number	:	215-699-9599

Provider Business Practice Location Address
First Line	:	118 DICKERSON RD
Second Line	:	SUITE D
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2538
Country	:	US
Telephone Number	:	215-699-0650
Fax Number	:	215-699-9599

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

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	04/10/2008

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