Provider Demographics
NPI:1043396534
Name:MULLEN, THOMAS W (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:MULLEN
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 1:2315 BECHELLI LN
Mailing Address - Street 2:STE F
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0119
Mailing Address - Country:US
Mailing Address - Phone:530-223-0436
Mailing Address - Fax:530-223-2649
Practice Address - Street 1:2315 BECHELLI LN
Practice Address - Street 2:STE. F
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0119
Practice Address - Country:US
Practice Address - Phone:530-223-0436
Practice Address - Fax:530-223-2649
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA476421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice