Provider Demographics
NPI:1487191094
Name:RICHARD C. MULLENS, DDS PLLC
Entity Type:Organization
Organization Name:RICHARD C. MULLENS, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CHANDLER
Authorized Official - Last Name:MULLENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-399-3163
Mailing Address - Street 1:3215 HENDRICKS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-4280
Mailing Address - Country:US
Mailing Address - Phone:904-399-3163
Mailing Address - Fax:904-399-5999
Practice Address - Street 1:3215 HENDRICKS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4280
Practice Address - Country:US
Practice Address - Phone:904-399-3163
Practice Address - Fax:904-399-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-22
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 12370261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental