Provider Demographics
NPI:1316438021
Name:MULHERIN, TANDI GLOUSE (DDS)
Entity type:Individual
Prefix:DR
First Name:TANDI
Middle Name:GLOUSE
Last Name:MULHERIN
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 1:800 E CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-1265
Mailing Address - Country:US
Mailing Address - Phone:417-235-5155
Mailing Address - Fax:
Practice Address - Street 1:800 E CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-1265
Practice Address - Country:US
Practice Address - Phone:417-235-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180177751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice