Provider Demographics
NPI:1194612697
Name:MULLANEY, KYLIE KAREN (DDS)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:KAREN
Last Name:MULLANEY
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 1:4429 W 52ND ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1313
Mailing Address - Country:US
Mailing Address - Phone:952-836-9500
Mailing Address - Fax:
Practice Address - Street 1:701 25TH AVE S STE 400
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1443
Practice Address - Country:US
Practice Address - Phone:612-839-7271
Practice Address - Fax:612-659-4901
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND153181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry