Provider Demographics
NPI:1417399171
Name:MULLET, ANDREW STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:STEVEN
Last Name:MULLET
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 1:1301 PLANTATION ISLAND DR S STE 104B
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3110
Mailing Address - Country:US
Mailing Address - Phone:904-461-5566
Mailing Address - Fax:904-461-0084
Practice Address - Street 1:1301 PLANTATION ISLAND DR S STE 104B
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3110
Practice Address - Country:US
Practice Address - Phone:904-461-5566
Practice Address - Fax:904-461-0084
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist