Provider Demographics
NPI:1588670939
Name:MAULDIN, MICHAEL LANDERS (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LANDERS
Last Name:MAULDIN
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 1:501 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-1605
Mailing Address - Country:US
Mailing Address - Phone:361-643-7811
Mailing Address - Fax:361-643-4028
Practice Address - Street 1:501 MOORE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-1605
Practice Address - Country:US
Practice Address - Phone:361-643-7811
Practice Address - Fax:361-643-4028
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist