Provider Demographics
NPI:1285771030
Name:ALBERT F MCMULLEN III DDS FDC
Entity type:Organization
Organization Name:ALBERT F MCMULLEN III DDS FDC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-322-0432
Mailing Address - Street 1:2005 FORSYTHE AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-322-0432
Mailing Address - Fax:318-322-4537
Practice Address - Street 1:2005 FORSYTHE AVENUE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-322-0432
Practice Address - Fax:318-322-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4293122300000X
LA5171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty