Provider Demographics
NPI:1376750273
Name:MULLINS, NAN HERRON (DMD)
Entity Type:Individual
Prefix:DR
First Name:NAN
Middle Name:HERRON
Last Name:MULLINS
Suffix:
Gender:F
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:PO BOX 30126
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1126
Mailing Address - Country:US
Mailing Address - Phone:850-477-5788
Mailing Address - Fax:
Practice Address - Street 1:4400 BAYOU BLVD
Practice Address - Street 2:BUILDING 17
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2673
Practice Address - Country:US
Practice Address - Phone:850-477-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN96841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice