MEDICARE: DR. SYDNEY ANN MULLINS 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	122300000X	Dentist	7323	KY

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	005171	OTHER	KY	PASSPORT/DORAL

General Provider Information

NPI Number	:	1932198199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SYDNEY ANN MULLINS DMD

Provider Business Mailing Address
First Line	:	1313 LYNDON LN
Second Line	:	SUITE 211
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7351
Country	:	US
Telephone Number	:	502-412-1166
Fax Number	:	502-339-0433

Provider Business Practice Location Address
First Line	:	1313 LYNDON LN
Second Line	:	SUITE 211
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7351
Country	:	US
Telephone Number	:	502-412-1166
Fax Number	:	502-339-0433

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/08/2007

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