Provider Demographics
NPI:1538291257
Name:NAN HERRON MULLINS,D.M.D., P.A.
Entity Type:Organization
Organization Name:NAN HERRON MULLINS,D.M.D., P.A.
Other - Org Name:SUMMIT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAN
Authorized Official - Middle Name:HERRON
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-477-5788
Mailing Address - Street 1:PO BOX 30126
Mailing Address - Street 2:4400 BAYOU BLVD., #17
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1126
Mailing Address - Country:US
Mailing Address - Phone:850-477-5788
Mailing Address - Fax:850-478-9339
Practice Address - Street 1:4400 BAYOU BLVD STE 17
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-1907
Practice Address - Country:US
Practice Address - Phone:850-477-5788
Practice Address - Fax:850-478-9339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN96841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty