MEDICARE: MULBERRY DENTAL, PLLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1881559045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULBERRY DENTAL, PLLC

Provider Business Mailing Address
First Line	:	1030 MULBERRY AVE
Second Line	:
City	:	SELMER
State	:	TN
Zip	:	38375-6629
Country	:	US
Telephone Number	:	731-646-0021
Fax Number	:	731-434-0382

Provider Business Practice Location Address
First Line	:	1030 MULBERRY AVE
Second Line	:
City	:	SELMER
State	:	TN
Zip	:	38375-6629
Country	:	US
Telephone Number	:	731-646-0021
Fax Number	:	731-434-0382

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	WHITNEY GOOCH
Credential	:
Telephone Number	:	731-646-0021

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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