Provider Demographics
NPI:1063674802
Name:MULLINS, JAMES HUGH (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HUGH
Last Name:MULLINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2042
Mailing Address - Country:US
Mailing Address - Phone:850-763-3622
Mailing Address - Fax:850-763-6175
Practice Address - Street 1:1010 W 11TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2042
Practice Address - Country:US
Practice Address - Phone:850-763-3622
Practice Address - Fax:850-763-6175
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist