Provider Demographics
NPI:1417030388
Name:MULHOLLAND, MARC E (DDS)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:E
Last Name:MULHOLLAND
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 1:916 WASHINGTON AVE
Mailing Address - Street 2:STE 914
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708
Mailing Address - Country:US
Mailing Address - Phone:989-892-9341
Mailing Address - Fax:989-892-7961
Practice Address - Street 1:916 WASHINGTON AVE
Practice Address - Street 2:STE 914
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708
Practice Address - Country:US
Practice Address - Phone:989-892-9341
Practice Address - Fax:989-892-7961
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0100101223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5097389Medicare ID - Type Unspecified
T82908Medicare UPIN