Provider Demographics
NPI:1053303966
Name:COOVER, MULLEN O (DDS)
Entity Type:Individual
Prefix:DR
First Name:MULLEN
Middle Name:O
Last Name:COOVER
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 1:173 ASHLEY AVE
Mailing Address - Street 2:BSB-335
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8908
Mailing Address - Country:US
Mailing Address - Phone:843-792-3765
Mailing Address - Fax:843-792-2847
Practice Address - Street 1:173 ASHLEY AVE
Practice Address - Street 2:BSB-335
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8908
Practice Address - Country:US
Practice Address - Phone:843-792-3765
Practice Address - Fax:843-792-2847
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24351223G0001X
SC36551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice