Provider Demographics
NPI:1306934989
Name:MULLIGAN, JAMES P (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:MULLIGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DOGWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2411
Mailing Address - Country:US
Mailing Address - Phone:386-668-4433
Mailing Address - Fax:386-668-4435
Practice Address - Street 1:9 DOGWOOD TRL
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2411
Practice Address - Country:US
Practice Address - Phone:386-668-4433
Practice Address - Fax:386-668-4435
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL73091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6605780001Medicare NSC