Provider Demographics
NPI:1245760859
Name:MICHAEL H MULKEY, DMD PC
Entity Type:Organization
Organization Name:MICHAEL H MULKEY, DMD PC
Other - Org Name:LOST MOUNTAIN DENTAL @ DUE WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MULKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-425-4001
Mailing Address - Street 1:3951 MARY ELIZA TRCE NW STE 200
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1078
Mailing Address - Country:US
Mailing Address - Phone:770-425-4001
Mailing Address - Fax:770-425-7636
Practice Address - Street 1:3951 MARY ELIZA TRACE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064
Practice Address - Country:US
Practice Address - Phone:770-425-4001
Practice Address - Fax:770-425-7636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty