Provider Demographics
NPI:1235274895
Name:MULLIN, SAMANTHA LYNN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LYNN
Last Name:MULLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N CLAY STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-2144
Mailing Address - Country:US
Mailing Address - Phone:417-468-2129
Mailing Address - Fax:417-859-0533
Practice Address - Street 1:211 N CLAY STREET
Practice Address - Street 2:SUITE B
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-2144
Practice Address - Country:US
Practice Address - Phone:417-468-2129
Practice Address - Fax:417-859-0533
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist