Provider Demographics
NPI:1124869425
Name:MULLINS, KRISTEN ALYSSA (DDS)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ALYSSA
Last Name:MULLINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 KANAWHA BLVD W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25387-2533
Mailing Address - Country:US
Mailing Address - Phone:304-345-7272
Mailing Address - Fax:304-345-7287
Practice Address - Street 1:1516 KANAWHA BLVD W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25387-2533
Practice Address - Country:US
Practice Address - Phone:304-345-7272
Practice Address - Fax:304-345-7287
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist