Provider Demographics
NPI:1053462622
Name:SYDNEY ANN MULLINS DMA
Entity Type:Organization
Organization Name:SYDNEY ANN MULLINS DMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-412-1166
Mailing Address - Street 1:1313 LYNDON LANE
Mailing Address - Street 2:STE 211
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222
Mailing Address - Country:US
Mailing Address - Phone:502-412-1166
Mailing Address - Fax:502-339-0433
Practice Address - Street 1:1313 LYNDON LANE
Practice Address - Street 2:STE 211
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-412-1166
Practice Address - Fax:502-339-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60073236Medicaid
KY4500353000OtherEPSDT