Provider Demographics
NPI:1134136955
Name:MULLEN, STEVEN RUSSELL (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RUSSELL
Last Name:MULLEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:751 MILLER DR SE STE G1
Mailing Address - Street 2:SUITE G-1
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-8993
Mailing Address - Country:US
Mailing Address - Phone:703-771-9887
Mailing Address - Fax:703-771-9007
Practice Address - Street 1:751 MILLER DR SE STE G1
Practice Address - Street 2:SUITE G-1
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-8993
Practice Address - Country:US
Practice Address - Phone:703-771-9887
Practice Address - Fax:703-771-9007
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics