Provider Demographics
NPI:1093713398
Name:MULVANY, DAMIEN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAMIEN
Middle Name:A
Last Name:MULVANY
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 1:3627 S PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3753
Mailing Address - Country:US
Mailing Address - Phone:303-781-0624
Mailing Address - Fax:303-781-9551
Practice Address - Street 1:3627 S PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3753
Practice Address - Country:US
Practice Address - Phone:303-781-0624
Practice Address - Fax:303-781-9551
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
CO1050941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice