Provider Demographics
NPI:1962550384
Name:MULLEN, MICHAEL JOSEPH III (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:MULLEN
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:943 WEST COUNTYLINE ROAD
Mailing Address - Street 2:WARMMISTER TOWNSHIP
Mailing Address - City:HATBORO P O
Mailing Address - State:PA
Mailing Address - Zip Code:19040-1008
Mailing Address - Country:US
Mailing Address - Phone:215-672-8388
Mailing Address - Fax:215-674-8848
Practice Address - Street 1:943 WEST COUNTYLINE ROAD
Practice Address - Street 2:WARMMISTER TOWNSHIP
Practice Address - City:HATBORO P O
Practice Address - State:PA
Practice Address - Zip Code:19040-1008
Practice Address - Country:US
Practice Address - Phone:215-672-8388
Practice Address - Fax:215-674-8848
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020371L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist