Provider Demographics
NPI:1003812538
Name:MULLENS, GREGG KENT (PHARMD; DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:KENT
Last Name:MULLENS
Suffix:
Gender:M
Credentials:PHARMD; DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SCHOOL ST
Mailing Address - Street 2:STE 6
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2436
Mailing Address - Country:US
Mailing Address - Phone:413-773-7766
Mailing Address - Fax:413-773-3050
Practice Address - Street 1:40 SCHOOL ST
Practice Address - Street 2:STE 6
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2436
Practice Address - Country:US
Practice Address - Phone:413-773-7766
Practice Address - Fax:413-773-3050
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158681223G0001X
NE52331223G0001X
MA19437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAXO8195OtherBLUE CROSS/BLUE SHIELD ID