Provider Demographics
NPI:1326062175
Name:MCMULLIN, MARIA TERESE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:TERESE
Last Name:MCMULLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 W STEIN RD
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:MI
Mailing Address - Zip Code:48145-9799
Mailing Address - Country:US
Mailing Address - Phone:734-457-3779
Mailing Address - Fax:
Practice Address - Street 1:116 COLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4104
Practice Address - Country:US
Practice Address - Phone:734-241-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010186671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice