Provider Demographics
NPI:1174202550
Name:MARIA T MCMULLIN DDS PLLC
Entity type:Organization
Organization Name:MARIA T MCMULLIN DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCMULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-241-5115
Mailing Address - Street 1:2950 W STEIN RD
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:MI
Mailing Address - Zip Code:48145-9799
Mailing Address - Country:US
Mailing Address - Phone:734-625-6967
Mailing Address - Fax:
Practice Address - Street 1:116 COLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4104
Practice Address - Country:US
Practice Address - Phone:734-241-5115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental