Provider Demographics
NPI:1639497472
Name:MULLANEY, KATHLEEN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
Last Name:MULLANEY
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 1:700 N FAIRFAX ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2040
Mailing Address - Country:US
Mailing Address - Phone:703-548-8584
Mailing Address - Fax:703-548-0014
Practice Address - Street 1:700 N FAIRFAX ST
Practice Address - Street 2:SUITE 230
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2040
Practice Address - Country:US
Practice Address - Phone:703-548-8584
Practice Address - Fax:703-548-0014
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist