Provider Demographics
NPI:1033705868
Name:MULLEN, MISHA RENEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MISHA
Middle Name:RENEE
Last Name:MULLEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 SOLON ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-3347
Mailing Address - Country:US
Mailing Address - Phone:504-494-3207
Mailing Address - Fax:
Practice Address - Street 1:2504 TULANE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7445
Practice Address - Country:US
Practice Address - Phone:504-304-9929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA71551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice