Provider Demographics
NPI:1003024316
Name:MULLINS, RICHARD KEITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KEITH
Last Name:MULLINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7205 DIXIE HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2176
Mailing Address - Country:US
Mailing Address - Phone:859-371-8686
Mailing Address - Fax:859-371-8699
Practice Address - Street 1:7205 DIXIE HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2176
Practice Address - Country:US
Practice Address - Phone:859-371-8686
Practice Address - Fax:859-371-8699
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY41351223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics