Provider Demographics
NPI:1992793178
Name:MULLINS, STEPHEN TODD (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:TODD
Last Name:MULLINS
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 1:1391 TURKEY NECK RD
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:MD
Mailing Address - Zip Code:21561-1165
Mailing Address - Country:US
Mailing Address - Phone:301-387-7763
Mailing Address - Fax:301-533-0322
Practice Address - Street 1:1279 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-4341
Practice Address - Country:US
Practice Address - Phone:301-533-0633
Practice Address - Fax:301-533-0322
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD130741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice