Provider Demographics
NPI:1356861785
Name:MULLINS, KAYLA MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:MICHELLE
Last Name:MULLINS
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:PO BOX 1691
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24143-1691
Mailing Address - Country:US
Mailing Address - Phone:540-230-4683
Mailing Address - Fax:
Practice Address - Street 1:6051 BELSPRING RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:VA
Practice Address - Zip Code:24141-8567
Practice Address - Country:US
Practice Address - Phone:540-639-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014157011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice