Provider Demographics
NPI:1437239704
Name:MULLEN, PETER PARKS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:PARKS
Last Name:MULLEN
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 1:64 OLD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3961
Mailing Address - Country:US
Mailing Address - Phone:860-355-3294
Mailing Address - Fax:
Practice Address - Street 1:16 SUNNY VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3323
Practice Address - Country:US
Practice Address - Phone:860-354-1400
Practice Address - Fax:860-354-5343
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT63141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice