Provider Demographics
NPI:1255687133
Name:MCMULLEN, ALBERT F III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:F
Last Name:MCMULLEN
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 FORSYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3608
Mailing Address - Country:US
Mailing Address - Phone:318-322-0432
Mailing Address - Fax:318-322-4537
Practice Address - Street 1:2005 FORSYTHE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3608
Practice Address - Country:US
Practice Address - Phone:318-322-0432
Practice Address - Fax:318-322-4537
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA42931223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics