Provider Demographics
NPI:1609945773
Name:MULVANEY DENTAL PC
Entity Type:Organization
Organization Name:MULVANEY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MULVANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-967-6744
Mailing Address - Street 1:7745 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4735
Mailing Address - Country:US
Mailing Address - Phone:847-967-6744
Mailing Address - Fax:847-967-1460
Practice Address - Street 1:7745 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4735
Practice Address - Country:US
Practice Address - Phone:847-967-6744
Practice Address - Fax:847-967-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty