Provider Demographics
NPI:1275614844
Name:MULCAHY, TIMOTHY IAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:IAN
Last Name:MULCAHY
Suffix:
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 1:1795 EL CAMINO ROAD
Mailing Address - Street 2:#100
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306
Mailing Address - Country:US
Mailing Address - Phone:650-328-1223
Mailing Address - Fax:650-327-8903
Practice Address - Street 1:1795 EL CAMINO ROAD
Practice Address - Street 2:#100
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306
Practice Address - Country:US
Practice Address - Phone:650-328-1223
Practice Address - Fax:650-327-8903
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31838OtherLICENSE NUMBER
CA31838OtherLICENSE NUMBER