Provider Demographics
NPI:1255501458
Name:MULLINS, EDWIN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:R
Last Name:MULLINS
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 1:268 1ST ST.
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067
Mailing Address - Country:US
Mailing Address - Phone:334-365-6379
Mailing Address - Fax:334-365-9296
Practice Address - Street 1:268 1ST ST.
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067
Practice Address - Country:US
Practice Address - Phone:334-365-6379
Practice Address - Fax:334-365-9296
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice