Provider Demographics
NPI:1235278672
Name:MULLOY, CHRIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:
Last Name:MULLOY
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 1:153 N AUTEN AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2752
Mailing Address - Country:US
Mailing Address - Phone:908-722-6373
Mailing Address - Fax:908-722-2496
Practice Address - Street 1:153 N AUTEN AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2752
Practice Address - Country:US
Practice Address - Phone:908-722-6373
Practice Address - Fax:908-722-2496
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01726800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist