Provider Demographics
NPI:1083623292
Name:TODD W MULLIKIN, DDS, PC
Entity Type:Organization
Organization Name:TODD W MULLIKIN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:MULLIKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-926-9914
Mailing Address - Street 1:3733 CANTON RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2663
Mailing Address - Country:US
Mailing Address - Phone:770-926-9914
Mailing Address - Fax:770-926-0306
Practice Address - Street 1:3733 CANTON RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2663
Practice Address - Country:US
Practice Address - Phone:770-926-9914
Practice Address - Fax:770-926-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty