Provider Demographics
NPI:1497043863
Name:MULLINS, STEPHANIE LAUREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LAUREN
Last Name:MULLINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 NE RALPH POWELL RD STE C
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2336
Mailing Address - Country:US
Mailing Address - Phone:816-719-3200
Mailing Address - Fax:
Practice Address - Street 1:3470 NE RALPH POWELL RD STE C
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2336
Practice Address - Country:US
Practice Address - Phone:816-719-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002011111122300000X, 1223E0200X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics